Ch CY2003

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality -
s+ELL CON I RACI Olt (INDIVIDUAL) NAME
E((print))� clG - (\I UA�r�
w F.LI. CONIIL\Cr 012 CO)11',\Nl' N,\PIE I Ut t) (X ti �( `�rl rsJC/ p
STAI l: w'.l.l. CONS. RUCrION l'EItMI7q ASSOCIATED wQ I'ERMITft
(if applicable) - (if applicable)
270094
Groundwater Section
CERTIFICATION P ) S % 1
IlONE # (354 r{(, 7-/1E-PI0
\VEI.I. USE (Check Applicable I3ox): Residential Ir " Municipal/Public O Industrial O Agricultural ❑
N lonitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other ❑ 11Olhcr, List Usc
2. \VELI, LOCATION:
Nearest Town: 1U piAl
lAV)17 CCRPPK
County 01f.12c Lee_
(StreetName. Numbers. Community, Subdivision, Lot No.. Zip Codel
3. OWNER: A114fZ �/
Address _ S Iz�(�4A�'/ u V)e DR
(Street or Route No-)
C mC us or I us State Zip Code
f')-8)- 731—`i1)
Area code- Phone number
d. DATE DRILLED cik103
5. TOTAL DEPTH: %Va
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: )j00 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
crop of casing terminated at/or below land surface requires a
variance in accordance with I5,\ NCAC 2C .UI Ia.
9. YILLD(gpin): `--" METHOD OFTEST At` Pdfr`P
0. WATER ZONES (depth):
I I . DISINFECTION: Type .LL.cRP`'C- Amount 100
12. CASING: Wall Thickness I
or Weight/Pt. Nlatclial
SuC-aL Lvu
Depth
From -I- To ,r
� Ft.
Front To Fl.
From To Ft.
Diameter
(,.0s
13. GROUT: Depth Material Method
From 0 To :I u Ft. toor-l( Q 63:K- 11‘"a „ ,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Et. in. in.
From To Ft. in. in.
15.SAND/GRAVL'.LPACK
:
Depth
From To
From To
16. I(ENIARKS:
Size _ M; ierial
Ft.
Ft.
(-I- C33
"topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Lat ilutle'longilude of well location
I degrcesaninulcs/sccundsl
Lalilude longitude source:❑GPSO topographic map
check box I
1)1111 1II DRILLING LOG
From To FortultiTi Description
6 t1V „Zola
may" .75 >r14 //or/ 6r'-"
ffF
/Y%%/ /4,7 <.
'fin//
st.�6 0
o - 5IS
598- 10)
/445 J)0
J•
� //
_l ' ���,, r) 6t-
-ld G ky
1�o�a (gay c-ack
_30I 8! "! 3 0 S.915
LOCATION SKEFCII
Show direction and distance in miles from at least
two Slate Roads or County Roads, Include the road
numbers and common road names.
O
w
co /3C
I DO HEREBY CERTIFY II FAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE \VIII I I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO IIIE WELL OWNER
S ll�t i T E OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Wader Quality, Groundwater Section, 1636 Mail Service Center - Italcigh,ING
27699-1636 Phone No. [phone], within 30 (10y5. GW-I REV. 07/200i

280882
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION # 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # (8?QLnzaooa....-
STATE WEI.I. CONSTRUCTION PERMIT# ASSOCIATED WI) PERMIT/4 _ (if applicable) (if applicable) -
1. WELL USE (Check Applicable Box): Residential El MunicipaUPublic ❑ industrial ❑ Agricultural ❑
Monitoring Cl Recovery ❑ Heat Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
CANDY MTN RD
County CHEROKEE
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: PHIL ARMSTRONG
Address 4627 30TH AVE. NORTH
(Street or Route No.)
ST. PETERSBURG. FL 33713
City or Town State Zip Code
( 727 )_ 528-2268
Area code- Phone number
4. DATE DRILLED 10-10-2003
5. TOTAL DEPTH: 385'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 68' ET.
(Ilse "+" 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 ISA NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST AIR
O. WATER ZONES (depth): 340'
I I. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 61 Ft. 6 1/8"
From To Ft.
From To It.
13. GROUT: Depth Malcrial Method
From 0 To 20 Et. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Et. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amount 100 PPM
Wall Thickness
or Weight/D. Material
SDR 21 PVC
From To Ft.
16. REMARKS:
'topographic/Land selling
❑Ridge ❑Slope ❑Valley ®Plat
(check appropriate box)
Latitude/longitude of well location
3506.223N/8414.962W I.-
(degrees/minutes/seconds)
Latitude/longitude source:OGPS®Topographic map
(check box) L- - -
DEPTH DRILLING LOG
From To Formation Description
0' TO 40' RED CLAY & SAND
40. TO 61' GRANITE
61' TO 385' GRANITE
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road namess.
ik
IWV 0Z13000
C
is
m
rn—
m�,
L DO HEREBY CERTIFY 1llAT THIS WELL WAS CONSTRUCTED IN ACC'.OILUANCI? WITH 15A NCAC 2C, WELL xD
CONSTRUCTION STANDARDS, AND AT A COPY TIIIS RE ORD HAS BEEN PROVIDED TO TILE WELL OWNER
SiTGNATUR�OF PER�6N C VI RUCTING'DIIE WELL DATE
Submit the original to the Division of Wafer Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
LARRY F. JONES CERTIFICATION a 3295
WEI.I. CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE a [phone]
STATE WELL CONSTRUCTION PERMIT ASSOCIATED WO PERMITl
(if applicable) (if applicable)
280882
I. WELL USE (Check Applicable Box): Residential O Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Othcr, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
TARHEEL NORTH
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOEY REID / RAY NEWCOMB
Address 5510 WEST U.S. HWY 64
(Street or Route No-)
MURPHY, NC
City or Town State
( 828 )- 837-9199
Area code- Phone number
4. DATE DRILLED 09-25-2003
28906
Zip Code
5. TOTAL DEPTH: 707'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ------ET.
(Ilse "a" if Above Top el 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 ISA NCAC 2C.0118.
9. YIELD (gpm). METHOD OF TEST AIR
10. WATER ZONES (depth):
Topographic/Land selling
9Ridge ❑Slope ❑Valley ❑Plat
(check appropriate box)
Latitude/longitude of well location
3505.2 52. N/8403.2 25 W
(degrecchni nu tes/seconds)
Latitude/longitude souree:®GPS0Topographic map
(check hox)
DEPTH DRILLING LOG
From To Formation Description
O'TO40' RED CLAY _.
40'TO50' BROWNDIRT
50' TO 80' GRANITE & QUARTZ
80' TO 707' GRANITE
I I. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 82 Et. 6118"
From To R.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
Amount 100 PPM
Wail Thickness
or WeighVEt. Material
SDR 21 PVC
Method
GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/(TRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from atteast:...-
two Stale Roads or County Roads. Include the road._
numbers and common road names.
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W IT 1115A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF 111IS IRE ORI) IRS BEEN PROVIDED TO TIIE WELL OWNER
A )-5 -ice
SIGNAIUI2EPF,RSONC)7fRI1C'ITNG THE WELL DATE
O
N
t,0
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Sera lee Centerl RaleiREVgh, NC
27699-1636 Phone Nit. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Departrnent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION # 3205
WELL. CONTRACTOR COMPANY NAh1E CHEROKEE WELL DRILLING AND PUMP COMPANY. INC. PHONE # [phone]
STATE WEI,L CONSTRUCTION PERMIT# ASSOCIATE!) WQ PERMIT#
(if applicable) .(if applicahlo) -
I. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial O Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: MARBLE
SLOW CREEK- HWY 141
County CHEROKEE
(Street Name, Numbers. Community, Subdivision. Lot No.. lip Code)
3 OWNER: RANDY DOCKERY
Address 5510 WEST U.S. HWY 64
City or Town State
( 828 )_ 837-9199
Area code- Phone number
4. DATE DRILLED 10-14-2003
5. TOTAL DEPTH: 205'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 ET. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 50 METHOD OE TEST AIR
IQ WATER ZONES (depth): 55'
(Street or Route No_)
MURPHY, NC 28906
Zip Code
I I. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 81 Et
From To Ft.
From To Ft
13. GROUT: Depth
From 0 To 20 Ft.
From To Ft.
14. SCREEN: Depot
Material
CEMENT
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft . Material
6 1/8" SDR 21 PVC
Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size
Met hod
GRAVITY
Slot Size Material
in.
in.
Material
16. REMARKS:
280884
Topographic/Land setting
❑Ridge ❑Slope ®Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopograp'tic map
(check hox)
DEPTH DRILLING C
From To Formation Description
0' TO 20' RED CLAY
20' TO 60' SANDSTONE
60' TO 81' BLUE SLATE
81' TO 205' BLUE SLATE
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
410
kr)
•
O
N
ID
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE. W'll l l I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A .OPY OF THIS RECORD I IAS BEEN PROVIDED TO TIIE WELL OWNER
[NCI 'I lIE WELL DATE
SIGNA'f
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Servlce Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC.
2.80885
- Groundwater Section
CERTIFICATION # 3295
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El MunicipaUPuhlic 0 Industrial ❑ Agricultural CI
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
BRASSTOWN HEIGHTS
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DAVID WATSON
Address P.O. BOX 1516
(Street or Route No.)
MURPHY, NC
City or Town Suite
( 828 )- 837-6373
Area code- Phone number
4. DATE DRILLED 09-30-2003
28906
Zip Code
5. TOTAL DEPTH: 50T
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
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 2C .011R.
9. YIELD (pm): --------- METHOD OF TEST AIR
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Fiat
(cheek appropriate box)
Latitude/longitude of well location.
pleprees/minutestsecundsl l
Latitude/longitude sourcc:OGPSOTodographic map
(check box)
DRILLING -LOCI -
Formation Description
SANDSTONE& GRANITE
22' TO 807' GRANITE
GRANITE
DEPTH
From To
0' TO 22'
I I. DISINFECTION: Type CHLORINE
12. CASING:
From 0
Depth
To 22
From To
From To Ft.
Amount 100 PPM
Wall Thickness
Diameter or Weight/FI. Material
Ft. 6 1/8" SDR 21 PVC
Ft.
13. GROUT: Depth
From 0 To 22
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
Material
Ft. CEMENT
Melhod
GRAVITY
Slot Size Material
in.
in.
Material
From To
16. REMARKS:
Ft.
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
0
CO
0
0
N
0
0
N
1.0
I DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIT II I5A NCAC 2C, WELL
CONSTRICTION STANDARDS, AND Ti IA';;i\ COPY OF TIIIS RE )RD IIAS BEEN PROVIDED TO (TIE. WELL OWNER
9-3o -yam
SIG DATE
N WPERS N CO7
RUCTING 'UHF WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-I REV. 07/2001

WELL CONSTRUCTION RECORD 28137 4
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CONTRACTOR (INDIVIDUAL) NAME (print) , 77 / eece_ CERTIFICATION a�3
WELL
i/7t I'f i Orilii ury� PHONE # DS,Z') 137-2f2
WELL CONTRACTOR COMPANY NAME '- �!E.D)
STATE WELL CONSTRUCTION PERMITS/ASSOCIAT WQ PERMIT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: 074-V
7-LL 4eJ
County Cle:.�e;ket:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWivER. 4Dl ,' et 47/<1orn
Address Il4%2- vJ UJ ULj
(Street or Route No.)
Cni�rk Nc r�7 U
cob
`` City or Tdwn State Zip Code
l�—r-
Area code- Phone number
4. DATE DRILLED e1/4 78-03 —
5. TOTAL DEPTH: 3DOt,1,7 YES❑ NO lY
6. DOES WELL REPLACE EX1S -.rcrtT.rWE
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate be )
Latitudc/longitudc of well location
A'J °07'/9-8"t&O5'9 Ir's-3 /"
(degrees/minutes/seconds)
Latitudc/Iongitude sourcc:LJUPS❑Topographic map
(check box)
p L1 DRILLINQI,OG
From To Fnrmation Description
7. STATIC WATER LEVEL Below Top of Casing: S' 0 FT.
(Use "+" if Above T'np et Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top orcasing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): / METHOD OF TEST
10. WATER ZONES (depth): //0
11. DISINFECTION: Type
12. CASING:
Depth
From To ?/)
Diameter
Ft. 6..2.5
Front To Ft.
From To Ft.
13. GROUT: Depth
From (t To
From To
14. SCREEN: Depth
From To
From To Ft.
15. SAND/GRAVEL PACK:
Amount iiy w�
Wall Thickness
or Weight/It. Material
64',2, Opt
�al Method
.-^7-
Ft.
Diameter Slot Size Material
Ft. in. in.
in. in.
From Ft.
From Ft.
Depth
To
To
Size Material
6/-4..
0
w
0
m
r_S
x>
LOCATION SKETCH g
Show direction and distance in mites 1:(sim atleast
two State Roads or County Roads. Include tkre road
numbers and common road names.
r—
16. REMARKS:
I DO HEREBY CERTIFY THAT T111S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenteri R. IVgh, C
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natur 1 Resourcesur- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME ((ppprii�nt)/ e-ty //'e t-�'C— CERTIFICATION NA VO
WELL CONTRACTOR COMPANY NAME .f ./71/- 1')C'I1 Or ill l('tom'
STATE WELL CONSTRUCTION PERDIITN ASSOCI ED WQ PERMITN(ifapplicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential a Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Flcat Pump Water Injection 0 Other ❑ If Other, List Use
281373
PHONE N 92b')
2. WELL LOCATION:
Nearest Town: '%%tn;th<y
07i+9i7�r(StreetName,Name, N/umben, Community, Subdivision, Lot No., Zip Code)
3. OWNER. C/ ferJen!,
Address IS1-1 eat C%m0.J 5 ci
(Street or Route No.) ���0�
ent_LrQ�-L\
City or Tedn State Zip Code
( Area code- Phone number fir"
7 _Q
4. DATE'DRILLED f
5. TOTAL DEPTH: 3V0
6 DOES WELL REPLACE EXISTING WELL? YES 0 NO
Comity C.A.—Ottt e e
7. STATIC WATER LEVEL Below Top of Casing: 3-0 pp.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires •
variance In accordance Ith ISA NCAC 2C .0I18.
9. YIELD (gpm): METHOD OF TEST ; /
10. WATER ZONES (depth): 3.2-5-
11, DISINFECTION: Type l7/7-H
12. CASING:
ptly7, PinterFrom 0 To bi Ft.6-2-/
.t
From To Ft.
From To Ft.
at rrJ al
Ft. cirlc./l
13. GROUT: Depth
From i To.
Amount
Noll T-birknrcc
or Weight/Ft. ivtatcria!
S%EZl "VG
Method
ICSSv C
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size Material
Frorn To Ft.
From To Ft.
Topographic/Land setting
DRidge ❑Slope DValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Nay` Sy 'df.S"cvo Sy° ot. oy.9
(degrees/minutes/seconds)
Latitude/longitude source:UGPS❑Topographic map
(check box)
�;L?TH DRILLINQI,OG
From To Formation Description
—ss-
5-5 -310
CI
S�
o
w
rn
Th
LOCATION SKETCH, 9 r`
Show direction and distance in miles m at:least
two State Roads nr County Roads. Include GC road
numbers and conunon road namcs.
16. REMARKS:
1 DO (HEREBY CERTIFY TFIATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA,A COP OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ler // "/% -0 3
DATE
SIGATURI<OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail SenIce Ceenterl R leigh, C
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD 2 813 7 2
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section yo3
/��t.e a L"— CERTIFICATION#
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ✓ r � p`
WELL CONTRACTOR COMPANY NAME //'/g€, kip 11 01ill,�,rl PHONEft Sd8)n
WELL
CONSTRUCTION ASSOCIATED WQ PERMIT#
STATE .Y.._ _ NSTRUCTION PERMITN_ (if applicable)
(if applicable'
1. WELL USE (Check Applicable Box): Residential G MunicipaUeubiie 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: tzt/ 7 County C..4e,e der- ❑Ridge OSlope ❑Valley ❑Flat
lia�a / v � (check appropriate box)
S /atitude/lon itudeofwelllocation
(Street Name,
Numbers, Community, Subdivision, Lot No., Zip Code) ' g ri o ,
�v3�" G,i Rl.c �•o8y o) od.)
3. OWNER: s/c✓et- &`fir" e_ - O atttAA ca3re,Stic
Latitude longitude se (degrees/minutes/seconds)
map
Address Nrm C:Pe1 5kat`, (check box)
/I��Cu 1�� (Street or Route No.) DE DRILLING LOG
t 10Y1, CAP)3h�733 Formation Description
From To
City or n State Zip Code
Area Phone number
4. DATE DRILLED / / - /3-03
5. TOTAL DEPTH: 7'/ o
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 12--
7. STATIC WATER LEVEL Below Top o fCCaOVng: O Casing)
FT
l
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118. ,
9. YIELD (gpm): { METHOD OF TEST
10. WATER ZONES (depth): C 1)
11. DISINFECTION: Type /V
12. CASING:
Depth
Frorn_f—To cc/ F
From To Ft.
From To Ft.
13. GROUT: Depth
From 7 To a=�
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
TT/
Amount -!0
Wall Thickness
piarieter or Weight/Ft. Material
t. G .AS" 5,4 2/ wt..
„Male/dpal
Ft/iv 774t11
Ft.
Diameter
Ft. in.
Ft. in.
Method
�J 47
5/41a
Slot Size Material
in.
in.
Size Material
0
c,
LOCATION SKETCH r,
Show direction and distance in miles farm at least
two State Roads or County Roads. Incla3e thOtad
numbers and common road names. w
IN)
0
—�I
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE- WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AT�) THAT A COPY OF THIS RECORD HAS BEEN PROVIDEb TO THE WELL OWNER
-a1
SIGIQS1Gl ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Centerl R IVgh, C
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD 2 813 6 7
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section ���
�e�ry /(CCCti CERTIFICATION #
WELL CONTRACTOR(INDIVIDUAL)NAME (p(print),ten
WELL CONTRACTOR COMPANY NAME »%u/�e/ Weil 0t'il It""� PHONE # Q/S'I R37-z?`?)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,/(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Er-Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION //f
Nearest Town:
Ccen1or (Street Name, Numbers,/, 4//�
Community, Subdivision, Lot No., Zip Code)
County Griffith
3. OWNER: 6-CreL/6 %.!(er
Address I1`6FJ 5<&t1r) "St F`) t'O T%?
(Street or Route No.)
IJj ci \ 2 tiSVA 4YR cl- r3-11ID-(133`I
City or Twain State Zip Code
Area code- Phone number /0 3l - e 3
4. DATE DRILLED
5. TOTAL DEPTH: VP-
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0—
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N35°U8' sf3"wOBY° 0.2' 4719.0''
(degrees/minutes/seconds)
Latitude/longitude source:OGPS❑Topographic map
(check box)
DEPTH PRILLING I OG
From To Formation Dc;cription
O -So 71/4"/
7. STATIC WATER LEVEL Below Top of Casing: 7Sv FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 5 METHOD OF TEST J72"
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From D To 0
From To
From To
13. GROUT: Depth
From 0 To90 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
//71f
Diameter
Ft. 6„25
Ft.
Ft.
Amount 'etc/
Wall Thickness
or Weight/Ft. Material
SD21
,Method
//2&Liar-C
From To Ft.
From To Ft.
c
W o
0
n
LOCATION SKETCH o ".-
Show direction and distance in miles frce at last
two State Roads or County Roads. Incltfdd the toad
numbers and common road names.
r
Li
L —
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d3-d3
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl R 1Vgh, C01
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
er
'
North Carolina - Department of Environment and Nat rat Resources - Division of Water Quality - CeRr°F[ CERTIFICATION auk `�c'
on
{e e
WELL CONTRACTOR (INDIVIDUAL) NAME (print)ft ?
ro7;•t j.j J-z i`J i
�i//Z' 1e11 ��il'�11i�(rr PIIONEN,...__
WELL CONTRACTOR COMPANY NAME,_ pSSOC1ATED WQ PERb11T8
STATE WELL CONSTRUCTION PERMITS rif epp.!tc_b!ea
if a livable
). \VELL USE (Check Applicable Box): Residential l MunicipaY1'ubiic ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Purnp Water Injection 0 Other 0 If Otter, List Use
Topographic/Land setting
[Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Lautudc/longitudc ofwell
l cat, /
ti.35" c'2 ' / 1- 9 ' w e
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
p PT tntr, r r�
From To Formation Description
281364
2. WELL LOCATION:
Nearest Town:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
City oCtown State
apt 57I7r A
Area code- Phone number C , '2 ' el4. DATE DRILLED / ---
5. TOTAL DEPTH: ;Z? D
6. DOES WELL REPLACE EXISTING WELL/ YES ❑ NO (Y
7. STATIC WATER LEVEL Below°7 Above T
(Use "op of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
•Top of casing terminated at/or below land surface requires ■
variance In accordance with ISA NCAC 2C .0119. =—
9. YIELD (gpm) i METHOD OF TEST z
10. WATER ZONES (depth): p2 00
Amount YQc
11. DISINFECTION: 'Cypc—Wall Thickness
12. CASING: epth Diameter or Weight/Ft. Material
.i rront�?_—Toil__ Ft. 6•G� sJ1zL—__
� C
From To Ft.
From To FL
etc al Method
13. GROUT: Depth Matrial sS�"e
From__I--) To ) 6 Ft. VD "i/�..— 74 d —rz
From To Ft.---_ 14. SCREEN: Depth Diameter Slot Size Material
From
To pt, in. in.
in.
Front
To Ft. in. --
15. SAND/GRAVEL PACK: Depth Size Material
From To FL From To Ft. _---
County C/e%i`od
0 - 55"
r nrnTlON SKFTC1
Show direction and distance in miles frIh at ast
two State Roads or County Roads. Inclide thrroad
numbers and common road names.
c
16. REMARKS:
•*mrF. NCAC
LL
I DO HEREBY CERTIFYAARD THIS THAT A COPYL WAS OF THIS RECORD HAS BEEN PROVEIDeD TO IM WELL OWNER
CONSTRUCTION STANDARDS,l d
��� `°a"— DATE
SIGNATU ' OF PERSON CONSTRUCTING THE WELL
Submit the original to lbe Division of Water Quality, Groundwater Section, 1636 Mall Service Center -Raleigh,
NC
27699-1636 Phone No. [phone], within 30 days. GWr1 REV. 1

WELL CONSTRUCTION RECOP?2
North Carolina - Department of Enviromnen[ and Natural Resources - Division of Water Quality CERTIFICATION k_t
WELL CONTRACTOR(INDIVIDUAL) NAME (print)PHONE #
WELL. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT'S
if a..Iicable
1. WELL USE (Check Applicable Box): Residential nunicipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
o�graphic/Land setting
CB edge NSIope ❑Valley ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
2S" » 8tf-12�—
te
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographi
(check box)
PRIL;MN2LQ_Q
Formation Dcac^Ption
281363
2. WELL LOCATION:
Nearest Town: YI
Se
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER
Address 1V
Pr
4.
5. Or
6. OES W ELL REPLACE EXISTING WELL? YES ❑ NO
7.
County&
Zip Code
ASSOCIATED WQ PERMIT#
if a. licabie
City or Town State
Area code- Phone number
DATE DRILLED llj
TOTAL DEPTEI: rtL )
D FT.
STATIC WATER LEVEL Below op(Use" of AboveTopofCasing)
8. TOP OF CASING IS
FT. Above Land Surfacc'
*Top of cuing terminated at/or below land surface requires a
varianceIn accordance with.. IS METIIOD OF TEST 1
NCAC 2C .01113.
9. YIELDELD(gPm)� —Q----
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
Frorn Li__ To.— 3c Ft.
From To Ft.
From
To Ft.
13. GROUT: Depth
From f) To_ ,air!'
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
To Ft
From
11�F Amount IS
Wall Thickness
Diameter or Weight/Et. Material
(—1
tv I COI (.14
Ft.
Diameter
Ft. in.
Ft. in.
Size
R.
Slot Site
in.
in.
Material
Method
Material
[Dieu.
From To
aft
1n - LJ�Q
I O AT1ON, SKETC'I
map I�t�
c
c�c
Show direction and distance in miles fr°'(r at Icast
two State Roads or County Roads. Inc13e th
{gad
numbers and common road names. CZ
N c
o ,.�)l
Luve5
7y
16. REMARKS:
1 DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
NC
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenteri REVgh, N001
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Naattyrat Resources - Division of Water Quality - Ground CATIONctio �6�
WELL CONTRACTOR (INDIVIDUAL) NAME (print) / �/ Ze et
ller Weli PHONE vi1 i
M �Zb')�-8'?�-=ys�
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMITM
(if aDPlicable)
STATE WELL CONSTRUCTION PERMITM
if a licablc
1. WELL USE (Check Applicable 13ox): Residential 8---Municipal/Public ❑ Industrial ❑ Agricultural D
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
U?S°v s'SX_c"a a.?• 7 '3Y:
,aLrit Q U2S� ihl w,c_ (de8rees/minutes/soconu3)
Latitude/longitude source:❑GPS❑Topographic uiap
(check box)
- -r
DEPTH
From To Formation v<.,..ription
281362
2. WELL LOCATION: O7 y � efL�2
Count Li/e
Nearest Town:
H4
(su-czt *r- Numbers, Community, Subdivisicu, Lot No., Zip Code)
CLr< / 48ov
3. OWNER:
Address
Stale Zip Code
City or Town
Arca code- Phone number ZZ'43
4. DATE DRILLED
5. TOTAL DEPTH: f Or
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0'
7. STATIC WATER LEVEL BelowtTop ofCassie nng:r f0aing) FT
8. TOP OF CASING IS l FT. Above Land Surface"
*Top of casing terminated at)or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gprn):.--- METHOD OF TEST %'� —.--
10. WATER ZONES (depth): 3 ye-
11. DISINFECTION: Type l7`ret
12. CASING:
Depth From D To/2(e
From To
From To
13. GROUT: Depth
From D To 10
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
From,
From
Diameter
Ft. 6-%s"
Ft.
Ft.
Arno c ,
Wall Thickness
or Weight/Ft. Material
alesIial
Ft. 0/744-ni
Ft.
Diameter
Ft. in.
Ft. in.
Ft.
Ft.
Method
Hess viz
Slot Size Material
in.
in.
Size Material
I
------r -ter^.
t oc�ATION SK T F »-�
Show direction and distance in miles fr n atiegt
two State Roads or County Roads. Inche the toad
numbers and cormnon road names. ca
rV
16. REMARKS: WELL
1 R CERTIFY THAT IS THAT A COPY OF TH S RECORD HAS EEN PROVIDED TO THE WELL OWNER
CONON STT RUCTICTI ON STANDARDS, AND l0 _ Z 'CY
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
NC
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentterl �Vgh, N001
27699-1616 Phone No. (919) 713 327I, within 30 days.
PIT
LTi
Ir,

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater aN Ntio nion
'O
CRTIFICATI
r.ab.) Ss37-Z`)4>
WELL CONTRACTOR (INDIVIDUAL) NAME (print PHONE
WELL CONTRACTOR COMPANY NAME i ASSOCIATED WQ PERMIT#
/if'applicable)
STATE WELL CONSTRUCTION 1ebPERMIT!!(ifapp i
1. WELL USE (Check Applicable Box): Residential P unicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water injection 0 Other 0 If Other, List Use
Topographic/Land setting
QRrdge ❑Slope ❑Valley ❑Flat
(check appropriate bm )
Latitude/longitude of well oG6tion N
(degtees/minutes/seconds) p m hiC n�;
Latitude/longitude source:❑GPS❑To og . p p
(check box)
tU1—AAN(• L Jli
Formation Deedption
281361
2. WELL LOCATION: n�\ _County��nPtne
Nearest Town: t I
(Street Name, Numbers, Community, Subdivisira, Lot No., Zip Code)
3. OWNER: TOvt,r t4 i • tooc6
Address I(Street or Route No.)
lxt Ory K7 y050 2-- — —
State Zip Code
City or Town
CAD- 231"0 Y9 8S Ares code- Phone number
4. DATE DRILLED/D`aD'n - __
TOT
AL riFPTH: °/f1/'
6. „G WEL L? VES 11 NO GY
6. DOES WELL Pups —nf'H. Y riiSTli..�
7. STATIC WATER LEVEL Below tTop o f^lsvnfopofca+ng)
8. TOP OF CASING IS _�__ _—
FT. Above Land Surface"
*Top of casing terminated at/or below land surface requtrrequiresa
vaccordance with IS METIIOD OF TESTAR__.---
9. YIELDIELD CAC 2C .0118.
(gpm):
10. WATER ZONES (depth):
Amount I4
11. DISINFECTION: Type Wall Thickness
12. CASING:ING: Depd Diameter or Weight/Pt. �Material
¢5 r 3"(—
.1 Front —To__ FL
From To Ft.
Front To Ft.
13. GROUT: Depth
Fron_a_ To_aQ_Ft. M
n raoinl eMethod
From To Ft._-- 14. SCREEN: Depth Diameter Slot Size Material
From
To Ft. in. in.
in.
From
To Ft. in.
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft.
From To Ft.
llE
From To
Ca o
n
t OCATI0 KETCH =.
Show direction and distance in miles from at (cast
two State Roads or County Roads. Incl'rlde th xoad
ntunbers and common road names. ep
co
7 C4
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,
CONSTR_ ION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE W
�t
SIGNATURE OF PERSON CONSTRUCTING THE WELL DAT
GW .07/2001
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Cent( elgh, N,Ctc-
27699-1636 Phone No. [phone], within 30 days. i To
Fr

WELL CONSTRUCTION RECORD
ion
North Carolina - Department oCEnviromnent and Natural Resources - Division of Water Quality - Groundwater SecCERTIFICATION #t L-' `
WELL CONTRACTOR (INDIVIDUAL) NAME (print) PHONE # E"r r
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT#
if applicable)
STATE WELL CONSTRUCTION PERMIT#
if applicable)
unici at/Public O Industrial ❑ Agricultural ❑
USE (neck Applicable Box): Residential IrYM P other n to nn,�r, r st ? tsc--------
), WE'LL ��- Water Injection n -
r-s n_......,.'v I I Held pump ..u__.. _..
Monitoring u ,........-., -
Topographic/Lam' setting
❑Ridge
riValicy r1F,at
❑Siop�
(check appropriate box)
Latitude/longitude of well location
rs�S 1 /r �3
(degrecsfm inu testseconds )
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH,
From To
Formation Dcacriiption
,
2. WELL LOCATION:
Nearest Town: 4r` County_
P(r rhi rP 0
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
Cow e&anket later
3. OWNER:
Address
City or Town Sete
Arracode- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: Q ' ----
6. DOES WELL REPLACE EXISTING WELL? YESEl ElNO FOr
7. STATIC WATER LEVEL Below tTop of se "+" Casing:
Above Top of Casing)
8. TOP OF CASING IS __�—.--
Fr. Above Land Surfaces
•Top of casing terminated aVor below land surface requires a
varianceaccordanceMETHOD OF TEST
9. YIELDELD(gP'n):
10. WATER ZONES (depth):
Amount
11. DISINFECTION: Type._.�-- Wall Thickness
12. CASING: Depth Diameter or Weight/Ft. Material
Front 2 Ft. ,2" _cYi t-
From To Ft.
From To Ft.
DeMatcriat Method
13. GROUT: To Q _ Ft a, Q
Froln�_ T° From To Ft
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft
From To
.1
Ft
Zip Code
Diameter
Ft. in.
Ft. in.
Slot Size Material
in.
in.
Size Material
281360
0
rTl
ION CKETCH I `=)=
Show direction and distance in miles fr6-m atea§t
two State Roads or County Roads. Include thi;rdad
numbers and conunon road names. o
0
rV
r
16. REMARKS: WELL
CERTIFY THAT THIS WELL WAS CONSrIRUCTED IN
ACCORDANCE HASccWITI I I5Acn Nr1A 2WELLOWNER
1 CONSTRUCTION
.-• •,DE. .
STANDARDS, ANII THAT A Cory O•
CONSTRU( IiON STA :D. 1 ^-.--
SIGNATURE OF PERSON CONSTRUCTING TILE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center] RRaaleigh, NC
27699-1636 Phone No. [phone], within 30 days.
DATE

(Street or Route No.)
25sq0
State Zip Code
Fromm— To __Six:.Ft. (r.
Fro /D To 1 Ft. 5
13. GROUT: Depth Material
From_a_-- TO ` ' Ft. ,00r1/411 cf
l rnm To Ft.
Depth Diameter
From O To 6 ' Ft. t,t)5
WELL CONSTRUCTION RECORD 2 813 5 9
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
R. CERTIFICATION #�40�/
WELL CONTRACTOR (INDIVIDUAL) NAME (plrint) tJ n✓ tF...C1 R. LA i\ )n PHONER# r`''I �324/6q
WELL CONTRACTOR COMPANY NAME iYi,IIPc 1 ,)f�Il C i\l tvl ) C
SSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential 0-- Municipal/Public ❑ Industrial 0 Agricultural E.
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
1
Topographic/Land setting
❑Ridge ❑Slope Galley ❑F12k
(check appropriate box)
Latitude/longitude of well location L
.35-°It' 29 ° t,ips-47' 3 L
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING r OG
Formation Dcscription
2. WELL LOCATION.
Nearest Town: nrJ r er-Os
CountyCjt P[Dhf P C
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:C(4;
Address
S
City or Town
Area code- Phone number
4. DATE DRILLED±2K-C:23
5. TOTAL DEPTH: BLS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 4-It>' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ( FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C METHOD Alit
TEST CZ9. YIELD (gpm):—
10. WATER ZONES (depth):
11. DISINFECTION: Typeh\ 1,0(1AS
12. CASING:
14. SCREEN: Depth
Fror To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
DiameterFt. in.
Ft. in.
Size
Ft.
Ft.
Slot Size
in.
in.
Amount IS
Wall Thickness
or Weight/Ft. Material
•SDr11
,19S' :Sleet
.s7C eL
Method
P4Su✓ r.
Material
DE
From To
0 - ID
/0 - ire
gg� t -
90 -- /v2a,'
1.2(c !LA"'
l L S r2F).S
CO
i OCATION S FK TCH m
Show direction and distance in miles from ?least _ 7
two State Roads or County Roads. Includer he road_,
numbers and common road names.
0
r
rV
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
4
SIGNATURE OF PERSON CONSTRUCTING THE WELL
ag-�,
DATE
r- ..
z
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceen`tteerl R leigh, 4C
27699-1636 Phone No. [phone], within 30 days.

WELL . CONSTRUCTION RECORD
♦t LILV
281358
North Carolina - Department of Environment and Natural Resources - Division of Water f)uality - Groumdwater Section
�C,'YIPS r� \A7.,15e�'rl CERTIe1CAT!ON#a4DU
WELL CONTRACTOR (INDIVIDUAL) NAME (print) C 1 PHONE # 14�y\ 4�`r`'—�
WELL CONTRACTOR COMPANY NAME YVLNPC t.JP.11 AAeAt; in G,
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential IYMunicipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:MtaCTh,/ Countysftt Pa_
2qt_/ //i(„Lied CS",e DQvn 5n/IC,AC/
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
.1Il4PiSSo^a4CS,Pri
�\ L259
(Street or Route No.) `����
nMevI I I
City or Town State Zip Code
3. OWNER: MC
Address PO
Area code- Phone number
4. DATE DRILLED '7 - 0
5. TOTAL DEPTH: a4-S`'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0
7. STATIC WATER LEVEL Below Top of Casing: 30 ' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS .3L FT. Above Land Surfaces
*Top of casing terminated atior below land surface requires a
variance in accordance with ISA NCAC 2C .0118. 9. YIELD (gpm): I OD METHOD OF TEST A i Q
10. WATER ZONES (depth): CoD rs rA A t7S', Li A4 i95'
11. DISINFECTION: Type%tW\ Pellpl s
12. CASING:
Depth Diameter
From O _To c4
From To Ft. (o, 0
From To Ft.
13. GROUT: Depth
From fJ To 45`
Froth Tn_ 14. SCREEN: Depth
From To
Topographic/Lama setting
DRidge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
t4 2Ae6' Ib"/ ul $cia/3'y'"
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Formation Description
Amount \C
Wall Thickness
or Weight/Ft. Material
,/ r8 SA0e
Material
Ft.
Ft.
Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft.
From To Ft.
DEPTH
From To
Method
Qressure.
e . rOn
.70 — a 4.5
Sint Size iviateriai
in.
C.7 0
0
O
--i
LOCATION SKETCH r =-
Show direction and distance in miles from at least
two State Roads or County Roads. Include the rot
numbers and common road names.
N
m
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUC 1 ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
C� 1/) P/)F9+" DATE
/ SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl R leigh, NC
i7Foo_1616 Phone No. [phone], within 30 days.

281270
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
Natural Ressourcces—DDivision of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME�,.(pprrint) `1� (UJ t r ' 1 y • (�'C't ` tS CCERTIFICATION8
WELL CONTRACTOR COMPANY NAME A`i\I(L'("E USE % F LLL1&SU PHONE #tirg CC
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) / (if applicable)
1. WELL USE (Check Applicable Box): Residential O/ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATIQN;
e To •
(Street N • e, Numbers, C
3. OWNER:„ !�
Address
(Street or R
J— 21 D5 line
rtY oszn5
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: ao FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance in accordapla with 15A NCAC D 01
9. YIELD (gpm): 11 QF TEST
10. WATER ZONES (depth): 03' -
ision, Lot No.,
Code)
No.
(Q rm MC,
Zip Code 9ZT1b
03
11. DISINFECTION: Type k
cH
12. CASING: ,Diameter
From C)TTolh
To � Ft. Fp'/t}ter
From To Ft.
From To Ft.
13. GROUT: Depth
From n Tom Ft.i
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount
Wall aThickness
" t j rem
Slot Size
in.
in.
Material
Topographic/Lan setting
[Ridge ❑Slope pp((fralley ❑Fla«
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
issonds)
Latitude/longitude source:OGPS❑Topograpjic map
(check box)
DR[LLING LOIr
To Formatio
ii i
DEPTH
From
IeV
34-c'
n
c
LOCATION SKETCH — o
Show direction and distance in miles from at 1- . st ±
two State Roads or County Roads. Include k e road
numbers and common road names.
6. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE wgLL 0 R
IGNATURE OF PERSON CONSTRUCTING THE WELL D,ATE /
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
9 03

281164
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CALVIN W. ROSE
WELL CONTRACTOR COMPANY NAME ROSE'S WELL DRILLING
CERTIFICATION ft 3327
PHONE p f 423) 442-3431
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable
I. WELL USE (Check Applicable Box): Residential Fa Municipal/Public ❑ Industrial ❑ Agricultural ❑
I
j '--,-'1--='t
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use -
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
DONELY RD - CANDY MOUNTAIN RIDGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED HILL
Address 2190 MUSKOGEE TRAIL
(Street or Route No.)
NOKOMIS, FL 34275
City or Town State Zip Code
( 941 L. 915-8847
Arca code- Phone number
4. DATE DRILLED 11-25-2003
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 126 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
*Top of casing terminated al/or below land surface requires a
variance In accordance with ISA NCAC IC .aJ la.
9. YIELD (gpm): 1 1/2 METHOD OF TEST air
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 72
From To
From To
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft.
Ft. 6 1/8" SDR 21
Ft.
Ft.
Material
Ft. CEMENT
Material
PVC
Method
GRAVITY
Slot Size Material
in.
16. REMARKS:
Topographic/Land setting j'
❑Ridge ®Slope ❑Valley ❑BIaL,'
(check appropriate box) 1:' :
Latitude/longitude of well locaticin _n
(degrees/minutes/seconds)
Latitude/longitude source:0GPSEITopor 'lfl4 map
(check box)
DRILLING LOG
Formation Description
CASING
DEPTH
From To
0' TO 72'
77 TO 700' SLATE
n
CO
tJ
m
C7
E.T.
LOCATION SKETCH
Show direction and distance in miles from at) 3st
two State Roads or County Roads. Include thtsoad cn
numbers and common road names. cn c;
rV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI-I ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HASEEN PROVIDED TO THE WELL OWNER
/f—�.'S -O
9
SIG ORE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
Cr)
ti
0
2

281165
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION N 3327
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CALVIN W. ROSE
WELL CONTRACTOR COMPANY NAME ROSE'S WELL DRILLING
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
f�7
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
WOLF MTN. ESTATES - TURKEY PEN RD
(Street Name, Numbers, Conanunity, Subdivision, Lot No., Zip Code)
3. OWNER: RICHARD SCHERREN
Address 1641 SW ABINGDON AVE
(Street or Route No.)
PORT ST LUCIE, FL 34953
City or Town State Zip Code
( 772 )_ 878-0306
Area code- Phone number
4. DATE DRILLED 11-19-03
5. TOTAL DEPTH: 500'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gl
7. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .a118
9. YIELD (gpm): 1 1/2 METHOD OF TEST air
10. WATER ZONES (depth): 115' -1 1l2 gpm
1 I. DISINFECTION: Type CHLORINE
Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 77 Ft. 6 1/8' SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 25 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Size Material
Ft.
Ft.
Topographic/Land setting z
®Ridge ❑Slope ❑Valley 0F14,
(check appropriate box)
Latitude/longitude of well location 4: -"
35D 2.31N/84D 18.30W
(degrees/minutes/seconds) �.
Latitude/longitude source:®GPSOTopograp*tap ti
(check box) ri
DEPTH DRILLING LOG rL—J
From To Formation De'criotion
0' TO 77' CASING
7TTO500' SLATE
U
n
m
C-)
1
C
LOCATION SKETCH 3
Show direction and distance in miles from at49ast IC:-2. F
two State Roads or County Roads. Include tbg{oad`_'.
numbers and common road names. ^> o
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII l5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T COPY OF 1-115 RECO HAS BEEN PROVIDED TO THE WELL OWNER
�6C�e 88-/9-03
S ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceentteer' RaVRaleigh, NCW 1
27699-1636 Phone No. [phone], within 30 days.

281166
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prht0 LARRY F. JONES CERTIFICATION N 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE N [phone]
STATE WELL CONSTRUCTION PERMIT" ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipaVPublic ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
MARTINS CREEK - FLOYD STALCUP RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN RITZ
Address 425 TARHEEL WEST DRIVE
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Code
( 828 )- 835-3613
Arca code- Phone number
4. DATE DRILLED 12-02-2003
5. TOTAL DEPTH: 205'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Usc " " 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 1SA NCAC IC .0118.
9. YIELD (gpm): 20 METHOD OF TEST AIR
10. WATER ZONES (depth): 165'
11. DISINFECTION: Type CHLORINE
12. CASING:
Amount 100 PPM
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 98 Ft. 6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth Material
To 20 Ft. CEMENT
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Method
GRAVITY
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat.
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) L
Latitude/longitude source:❑GPS❑Topographer ma
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 80' RED CLAY
80' TO 98' GRANITE
98' TO 205' GRANITE
Uv
J
SLATE
W G
t=k U:_
c-) F.
LOCATION SKETCH I 5 <-
Show direction and distance in miles from al�east'v
two State Roads or County Roads. Include t3 road; c
numbers and common road names.
71
UT 0
rV c 4T
16. REMARKS:
I DO HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WRIT I5A NCAC 2C, WELL
CONST RUCTION STANDARDS, AND THAT,f1 COPY OF THIS RECORR HAS BEEN PROVIDED TO TFIE WELL OWNER
SIG N4'iTUREAPrPERS014�ONSTIidM1ING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. G W-1 REV. 07/2001

281167
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
MARTINS CREEK - FLOYD STALCUP RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION # 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE s [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) of applicable)
n
1. WELL USE (Check Applicable Box): Residential ® MunicipaVPublic 0 Industrial O Agricultura'
Monitoring ❑ Recovery O Heat Pump Water Injection ❑ Other 0 If Other, List Use -c
rno
Topographic/Land settai
®Ridge ❑Slope ❑Valley
(check appropriate box) z cn
Latitude/longitude of well ciegj
C-
3. OWNER: MARK RITZ (degrees/minutes/second a
Address 20 JEEP DR Latitude/longitude source:OGPSfratio
(Street or Route No.) (check box,
MURPHY, NC 28908 DEPTH D
City or Town State Zip Code From To Formation Description
( 828 )_ 269-4664 0' TO B0' RED CLAY
Area code- Phone number 80' TO 95' SAND
4. DATE DRILLED 12-01-2003 95' TO 105' BROWN DIRT
5. TOTAL DEPTH: 505' 105' TO 138' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El 138' To 505' SLATE
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfaces
"Top of easing terminated aUor below land surface requlrn •
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST AIR
10. WATER ZONES (depth): 430'
I I. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 138 Ft. 6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH w
Show direction and distance in miles from gleasl=>•,
two State Roads or County Roads. Include thic road c.
numbers and common road names. 1
co
-v
1 DO IIEREBY CERTIFY THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY F TI US RECORD HA& EEN PROVIDED TO THE WELL OWNER
`' `� / z-i-03
SIGNATURE 1 PERSO
THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
q)
r

2H2.f l8
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION N 3228
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE N 82
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT#
If a r r licable
(if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Usc
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
VALLEY RIVER MTN - LISA LN
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIM MERRICK
Address 5352 NORTH CROSS GATE
(Street or Route No.)
BEVERLY HILLS, FL 352
City or Town State Zip Code
( 352 )- 586-8784
Area cote- Phone number
4. DATE DRILLED 11-28-2003
5. TOTAL DEPTH: 707'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 180 ET.
(Use '4" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
*Top of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): PINT METHOD OF TEST AIR
10. WATER ZONES (depth):
1 I. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 64 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
6 1I8" SDR 21 PVC
Material
Ft. CEMENT
Method
GRAVITY
Topographic/Land sett
®Ridge ❑Slope ❑Valley
(check appropriate box)
Latitude/longitude of well 1
3508.089N/8357.374W
(degreesiminules/seconds)
Latitude/longitude source:EIGPSDT
(check box)
DRILLING LOG
Formation Description
RED CLAY
40' TO 64' SLATE
64' TO 707' SLATE
DEPTH
Frain To
0' TO 40'
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
0
O w
n
LOCATION $KETCH oI "'=
Show direction and distance in miles from at least > ,
two State Roads or County Roads. Include tl road^--
numbers and common road names. w ,o �^ '
f crl _t
PO
L
0
UL
1 DO HEREBY CERTIFY TILAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE. W I TII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A a PY OF THI$1ZECORij HAS BEEN PROVIDED TO THE WELL OWNER
GI-2.6; -03
SIGNA 4RE OF IUCTtNG TILE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenter' Raleigh, NC
27699-1636 Phone No. [phone], within 30 days.

281163
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION'S 3327
WELL CONTRACTOR(1NDIVIDUAL)NAME (print) CALVIN W. ROSE
WELL CONTRACTOR COMPANY NAME ROSE'S WELL DRILLING
STATE WELL CONSTRUCTION PERMIT'S ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
PHONE # f 423) 442-3431
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural ❑ rn
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
DONELY RD - CANDY MOUNTAIN RIDGE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ED HILL
Address 2190 MUSKOGEE TRAIL
(Street or Route No.)
NOKOMIS, FL 34275
City or Town State Zip Code
( 941 )- 915-8847
Area code- Phone number
4. DATE DRILLED 11-26-2003
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 94 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of using terminaled al/or below land surface requires a
variance In accordance with 15A NCAC 2C .011&
9. YIELD (gpm): 9 METHOD OF TEST air
10. WATER ZONES (depth): 335' - 5 GPM
545' -4 GPM
I1. DISINFECTION: Type CHLORINE
12. CASING:
From 0
Depth
To 89
From To
From To Ft.
13. GROUT: Depth
From 0 To 20
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 1/8" SDR 21 PVC
Ft.
Material Method
Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Topographic/Land settin
®Ridge ❑Slope DValley
(check appropriate box)
Latitude/longitude of well toe flail,
35D 5.18N/84D 18.35W 77'
(degas/minutes/seconds) =3' c U'Jn.
Latitude/longitude source:K1GPS❑Top6 rap ui c n(ap=--- -a
(check box) 1 t`_.. J )
DEPTH DRILL -WIG -LPG
From To Formation Description
0' TO 89' CASING
89' TO 800' SLATE
Slot Size Material
in.
in.
From To Ft.
16. REMARKS:
fA
0
r7
LOCATION SKETCH i
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roaeb
numbers and common road names.
r.J
11)0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE
CONSTRUCTION STANDARDS, AND 11/ A COPY OF THIS RECO ]D HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mal) Service Center - RaleiREVgh, NC
27699-1636 Phone No. [phone], within 30 days.
c

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED( WO PERMIT#
(if applicable) (if applicable)
282077
- Groundwater Section
CERTIFICATION # 3295
PHONE # [phone]
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial O Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Usc
2. WELL LOCATION:
Nearest Town: MURPHY
112 CLEARVIEW LN, BOILING SPRINGS
County CHEROKEE
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: AUSTIN & DIANE CROWDER
Address 9385 SE 145TH PLACE
(Street or Route No.)
SUMMERFIELD. FL 34491
City or Town State Zip Code
( 352 )_ 347-0881
Area code- Phone numbed
4. DATE DRILLED 10-21-2003
5. TOTAL DEPTH: 305'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 94 ET.
(Use "r- if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surfaces
*Top of casing terminated aUnr below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST AIR
10. WATER ZONES (depth):
"1 opographic/Land setting
®Ridge ❑Slope OVallcy Mat
(cheek appropriate box)
Latitude/longitude of well location
3512.748N/8358.416W
(degrees/minutes/seconds)
Latitude/longitude source:K1GPSOTopog[apfri# map
(cheek box)
DRILLING LOG L----'
DEPTH
From To
0'TO 15'
15' TO 30'
30' TO 4 T
47' TO 50'
50' TO 80'
80' TO 305'
Fomiation D..nulptiuu
BLACK DIRT
GRAVEL
GRANITE
OPEN POCKET
GRANITE
GRANITE
O
CO
O
rn
c
0
—i c
N o_
a
1 I. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 80 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
6 1/8" SDR 21 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Method
GRAVITY
Slot Sizc Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Sizc Material
Froln To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH U,z
Show direction and distance in miles from ate east c:
two Stale Roads or County Roads. Include tigioad=
numbers and common road names.
I DO HEREBY CERTIFY IIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI III I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TN✓AT A COPY OF TIIL 2F.CORD I IAS BEEN PROVIDED TO THE WELL OWNER
UAfE
SIGNAL;
12144.
NSTRLIC"LING 'IIIH WELL
Submit the original to the Division of Water Quality, Groundwater Section, 16.16 Mall Senice Center - Raleigh, NC
27699-1636 ('hone No. [phone], within 30 days. GW-I REV. 07/2001

282076
WELL CONSTRUCTION RECORD
North Carolina - Department of Envirotunent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION,/ 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PIIONE 4 [phone]
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ti0 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
2401 DAVIS CREEK RD
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JACK BUTTS
Address 828 FOOTHILLS DR
(Street or Route No.)
CLEVELAND, GA
30528
City or Town State Zip Code
( 706 )- 219-2285
Area code- Phone number
4. DATE DRILLED 10-16-2003
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 15 FT.
(Use "F" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1/2 METHOD OF TEST AIR
10. WATER ZONES (depth):
Topographic/Land setting
Midge DSlope ['Valley ®Plat
(check appropriate box)
Latitude/longitude of well location
3512.093N/8402.411 W
(degrees/minutes/seconds)
Latitude/longitude source:®GPSOTopographi
(check box)
DEPTH
From To
0' TO 15'
15' TO 20'
20' TO 45'
45' TO 505'
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 45
From To
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
Et. 6 1/8" SDR 21 PVC
Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Et. CEMENT
Method
GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Frotn
16. REMARKS:
To Ft.
DRILLING LOG
Formation Description
RED CLAY
BOULDERS
GRANITE 8 QUARTZ
GRANITE
0
CO
0
--f
c
c
cr
fV c3:
LOCATION SKETCH "Vr^
Show direction and distance in miles from at (Vast nix;
two State Roads or County Roads. Include thre oad
numbers and common road names. o
S
11)0 HEREBY CERTIFY.' IIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W I I I I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT Ayr OF TH)S RECO 20 HAS BEEN PROVIDED TO TIIE WELL OWNER
J /6-0'3
SIGNAT
JCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. (90) 733-3221, within 30 days. GW-1 REV. 07/2001

281802
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pin() LARRY F. JONES CERTIFICATION a 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE N [phone]
STATE WELL CONSTRUCTION PERMITII ASSOCIATED WQ PERMITS/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Punip Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
LOVINGOOD RD TO SUNNY LN
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: BRAD MUSE
Address 50 CAMEO LN
(Street or Route No.)
MURPHY, NC 28906
City or Town Smte Zip Code
( 828 )- 837-7427
Area code- Phone number
4. DATE DRILLED 11-19-2003
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "*" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
`Top of axing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C ,0118.
9. YIELD (gpm): 7 METHOD OF TEST AIR
10. WATER ZONES (depth): 160'
1 I. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 71 Ft. 6 tar
From To Ft.
From To Ft.
Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR21 PVC
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
l4. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Slot Size Material
in.
in.
Size Material
Topographic/Land setting •,_
❑Ridge KiSlope ❑Valley ❑f[',tai
(check appropriate box) i r—'
Latitude/longitude of well locati(in..,
(deanatininutcslseconds)
Latitude/longitude source:❑C3PS❑Topo aphic nIa l
(check box)
DRILLING LOG
Formation Description
RED CLAY
40' TO 71' BLUE SLATE
71' TO 505' BLUE SLATE
GRANITE
ra
cm
Ui
DEPTH
From To
0' TO 40'
m
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and cotnmon road names.
I DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T T A COPY ()urns RE RD HAS BEEN PROVIDED TO THE WELL OWNER
S NATUF PERSON C($g`tRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Sen Ice Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
281801
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prin0 LARRY F. JONES CERTIFICATION # 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El MunicipaUPublic ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
BERGAN MOORE RD - EAGLE MTN. PROPERTIES
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES K. MCBRIDE
Address 5085 BOYSCOUT RD.
(Street or Route No.)
BLAIRSVILLE, GA 30512
City or Town State Zip Code
( 828 )_ 835-8900
Area code- Phone number
4. DATE DRILLED 11-17-2003
5. TOTAL DEPTH: 807'
6. DOES WELL REPLACE EXISTING WELL? YES D NO
7. STATIC WATER LEVEL Below Top of Casing: 20 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .a118.
9. YIELD (gpm): 1 METHOD OF TEST AIR
10. WATER ZONES (depth):
Topographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) rn
Latitude/longitude sourcc:OGPSDTopographi4 map �--�
(check lox) II
DEPTH DRILLING LOG
From To Formation Description
0' TO 20' SLATE
20. TO 36' GRANITE
36' TO80T GRANITE
BLUE SLATE
11 DISINFECTION: Type CHLORINE
12. CASING
Depth Diameter
From 0 To 36 Ft. 6 1/&
From To Ft.
From To Ft.
13. GROUT: Depth Material
Front D To 20 Ft. CEMENT
Ainount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Et.
From To Ft.
Method
GRAVITY
Slot Size Material
in.
in.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at (east
two State Roads or County Roads. Include the road
numbers and common road names.
I DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII ISA NCAC 2C, WELL
CONS I-RUCFION STANDARDS, AND TILAT)y1COPY OF TIES RECOR9IIAS BEEN PROVIDED TO THE WELL OWNER
1/—/7.0 3
SIG
ERSON CONS
C ING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
281800
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION 8 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE I [phone]
STATE WELL. CONSTRUCTION PERMIT,/ ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection O Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
BERGAN MOORE RD - EAGLE MTN. PROPERTIES
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES K. MCBRIDE
4
5
6
7
Address 5085 BOYSCOUT RD.
(Street or Route No.)
BLAIRSVILLE, GA 30512
City or Town State Zip Code
( 828 ). 835-8900
Area code- Phone number
DATE DRILLED 11-13-2003
TOTAL DEPTH: 887'
DOES WELL REPLACE EXISTING WELL? YES 0 NO tig
STATIC WATER LEVEL Below Top of Casing: 560 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated alior below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST AIR
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) :
Latitude/longitude source:OGPSOTopogaphtc nrap 17
(check box) l�
DEPTH DRILLINQ LOG
Formation Description
SANDSTONE
20' TO 50' RED CLAY
50' TO 70' BLUE SLATE
BLUE SLATE
From To
0' TO 20'
70' TO 887'
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 70 Ft.
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Prom To Et. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Frorn To Ft.
Method
GRAVITY
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIDE I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CSd?Y OF THI RECO IAS BEEN PROVIDED TO THE WELL OWNER
fr-is-o3
TING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION N 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. pIoNE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential al Municipal/Public O Industrial 0 Agricultural O
Monitoring O Recovery O Heat Pump Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
BERGAN MOORE RD - EAGLE MTN. PROPERTIES
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES K. MCBRIDE
Address 5085 BOYSCOUT RD.
(Street or Route No.)
BLAIRSVILLE, GA 30512
City or Town State lip Code
( 828 )_ 835-8900
Arca code- Phone number
4. DATE DRILLED 11-10-2003
5. TOTAL DEPTH: 1007'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO EU
7. STATIC WATER LEVEL Below Top of Casing: 120 FT.
(Use "1-" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of caring terminated tiller below land surface requires •
variance In aceoniance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1(4 METHOD OF TEST AIR
10. WATER ZONES (depth):
'Ibpographic/Land setting
®Ridge ❑Slope OValley ['Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/mirages/seconds)
Latitude/longitude source:OGPSOTopogr phic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 40' SANDSTONE
40' TO 60' RED CLAY
281799
60' TO 71'
71' TO 1007'
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 71 Ft. 81/8"
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
Material
Ft. CEMENT
Amount 100 PPM
Wall Thickness
or Weight/Ft. Malerial
SDR 21 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in
From To Ft. in
15. SAND/GRAVEL PACK:
Depth Size Material
Method
GRAVITY
Slot Size Material
in.
in.
from To Ft.
From To Ft.
16. REMARKS:
BLUE SLATE
BLUE SLATE
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the toad
numbers and common road names.
e
I DO HEREBY CERTIFY TI IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A,'OPY OF THIS RECOILI�-kLAS BEEN PROVIDED TO TIIE WELL OWNER
/) -JD -o
NG THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall SenIte Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 181 Municipal/Public 0 Industrial 0 Agricultural 0
281'798
- Groundwater Section
CERTIFICATION N 3295
PHONE It (828) 839
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
BERGAN MOORE RD - EAGLE MTN. PROPERTIES
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES K. MCBRIDE
Address 5085 BOYSCOUT RD.
(Street or Route No.)
BLAIRSVILLE, GA
City or Town State
( 828 )- 635-8900
Area code- Phone number
4. DATE DRILLED 11-05-2003
30512
Zip Code
5. TOTAL DEPTH: 787'
6. DOES WELL REPLACE EXISTING WE.LL7 YES D NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "4-" if Above Top of Casing)
8. TOP OF CASING 1S I FT. Above Land Surface*
'Top or casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OP TEST AIR
I D. WATER ZONES (depth):
Topographic/Land setting
BiRidge ❑Slope ❑Valley ❑Flab
(check appropriate box) 4,
Latitude/longitude of well location♦ ".
3503. 110N/8401.920W
(degrees/minutes/seconds)
Latitude/longitude source:KIGPSDTopogr
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 60' RED CLAY
GRANITE
60' TO 91'
91'TO787' GRANITE
II. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 91 Ft. 61/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
Front 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
LOCATION SKETCII
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and comtnon road names.
16. REMARKS:
11)0 HEREBY CERTIFY THAT TILLS WELL WAS CONSTRUCTED IN ACCORDANCE W ITII ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT jCOPY OF TIITIS RECO*9 HAS BEEN PROVIDED TO THE WELL OWNER
SIGNAiURE O ERSONiCITING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall SenvIce Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION N 3327
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CALVIN W. ROSE
WELL CONTRACTOR COMPANY NAME ROSES WELL DRILLING
281797
PRONE N [phone]
STATE. WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® MunicipaVPublic 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
WOLFCREEK AREA
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: GERALD LONG
Address 151 LITTLE CREEK CROSSING
(Street or Route No.)
CHERRY LOG, GA 30522
City or Town State Zip Code
( 706 )_ 838-701
Area code- Phone number
4. DATE DRILLED 11-13-2003
5. TOTAL DEPTH: 460'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "}" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
"fop of easing terminated atfor below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 8 METHOD OF TEST AIR
10. WATER ZONES (depth): 2 GPM @ 220'
6 GPM @ 445'
1 I. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 61/8" SDR 21 PVC
From To
From To
13. GROUT: Depth Material Method
From 0 To 70 Ft. CEMENT PUMPED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ft.
Ft.
Ft.
16. REMARKS:
TopographidLand setting
❑Ridge ®Slope ❑Valley UFtai
(check appropriate box) ._'-'1 !
Latitude/longitude of well Ioc*'tiof) I ;Al
3501249N/8418.077W .7"
(dcpfccs/minutcs/scconds)
Latitudc/longitudc source:F3GPSOTop
(check box)
DEPTH DRILL
From To Formation Description
0' TO 20' RED CLAY
20'TO45' SANDSTONE
45' TO 70' GRANITE
70' TO 460' GRANITE
m
graphic toff.—
air]
LOCATIONSKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
-7PtJr) _
I DO HEREBY CERTIFY.' HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W ff II I5A NCAC 2C, WELL
77
CONSTRUCTION STANDARDS, AND TIJA4 , COPY OF THIS CORDHAS BEEN PROVIDED TO THE WELL OWNHRII
.
1412—
SIGNATURE OF PERSON CONS '(RUC LNG THp, WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Sen lee Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
//-13-03

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION M 3327
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CALVIN W. ROSE
WELL CONTRACTOR COMPANY NAME ROSES WELL DRILLING
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
283143
PHONE [phone]
I. WELL USE (Check Applicable Box): Residential 1 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
12109 U.S. I -WY 64 WEST
(Street Name, Numbers, Commrmity, Subdivision, Lot No., Zip Code)
3. OWNER: WILLIAM "LUCKY" JENKINS
Address 12109 WEST U.S. HWY 64
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Code
( 828 )- 644-5745
Area code- Phone number
4. DATE DRILLED 11-11-2003
5. TOTAL DEPTH: 300
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
"Top of casing terminated aUar below land surface requires •
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gout): 4 METHOD OF TEST AIR
10. WATER ZONES (depth): 90' - 1 1/2 GPM, 140' - 1 1/2 GPM,
County CHEROKEE
265' - 1 GPM
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 61 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
6 1/8" SDR 21 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Topographic/Land setting ! ,
°Ridge ❑Slope ®Valley ❑$tat,; I
(check appropriate box) , i
Latitude/longitude of well locatidn
3501479N/8412.115W I r '
(de(rces/minutcs/seconds) i - 1
Latitude/longitude sourcc:E3GPS°ToporSphimap
(check box)
DEPTH DRILLI G L -
From To Formation escnption
0' TO 61' SET CASING
61' TO 300' SLATE
Method
GRAVITY
Slot Size Material
in.
in.
Size Material
16. REMARKS:
1 00 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T1T A COPY OF DEEISSRRECORD HAS BEEN PROVIDED TO TILE WELL OWNER
ELUL—
SIG CURE OF PERSON CONSIRUCfING'CIIF. WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raeigh, NC 2iJ01
27699-1636 Phone No. [phone], within 30 days.
G c ,
T
LOCATION SKETCH " 2"'
Show direction and distance in miles from atCRast "=
two State Roads or County Roads. Include the road2
numbers and common road names.
�ti w€5r

283142
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 3327
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CALVIN W. ROSE
WELL CONTRACTOR COMPANY NAME ROSES WELL DRILLING
STATE WELL CONSTRUCTION PERMITH
(if applicable)
PHONE # [phone]
ASSOCIATED WQ PERMIT#
(if applicahle)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial Cl Agricultural 0
f
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
NORTH OAK ESTATES
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER: JAMES MONEYMAKER
Address 1285 WEST U.S. HWY 64
(Street or Route No.)
MURPHY, NC
28906
City or Town State Zip Code
( 828 )- 837-4488
Area code- Phone mrmber
4. DATE DRILLED 11-10-2003
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 120 ET.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of easing terminated ator below land surface requires a
variance in accordance with 15A NCAC 1C .0118.
9. YIELD (gpm): 2 METHOD OF TEST AIR
10. WATER ZONES (depth): 160' - 1/2 GPM, 280' - 1 1f2 GPM
1 I. DISINFECTION: Type CHLORINE
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From 0 To 70 Ft. 6 1/8" SOR 21
Frotn To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Amount 100 PPM
Material
PVC
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
®Ridge ❑Slope ❑Valley IJFtati
(check appropriate box)
Latitude/longitude of well locakipn
35D6.85N/84D4.83W
(degrees/minutes/seconds) 11)
Latitude/longitude source:®GPSOTopp tic map
(check box) i
DRILL
Formation
SET CASIN
SLATE
DEPTH
From To
0' TO 70'
70' TO 600'
W
LOCATION SKETCH —O r. c.
Show direction and distance in miles from a east ,rr
two State Roads or County Roads. Include t roa€,'
73
numbers and common road names.
Rr1e"2
O
.— o
('4
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 HAS BEEN PROVIDED TO TILE WELL OWNER
ff���!!! //—/0 --03
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of'Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CALVIN W. ROSE CERTIFICATION N
3327
PHONE g f 423) 442-3431
WELL CONTRACTOR COMPANY NAME ROSES WELL DRILLING
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
282783
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0 y'.,-
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
2569 BOILING SPRINGS RD
(Street Name, Numbers, Community, Subdivision, Int No., Zip Code)
3. OWNER: DONALD A. FOSTER
Address 4104 WASHINGTON AVE
(Sheet or Route No.)
PASCAGOULA, MS
39581
City or Town Stale Zip Code
( 228 )- 762-9367
Area code- Phone number
4. DATE DRILLED 11-03-2003
5. TOTAL DEPTH: 600'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use"r" if Above Top of Casing)
8. TOP OF CASING 1S 1 112 FT. Above Land Surface*
'Top of casing terminated at/or helms land surface requires a
variance in accordance with ISA NCAC 2C .0116.
9. YIELD (gpm): 1 1/2 METHOD OF TEST AIR
ID. WATER ZONES (depth): 160' - 200'
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 31
From To
From To
13. GROUT: Depth
From 0 To 20
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 1/8" SOB 21 PVC
FL
Ft.
Material
Ft. CEMENT
From To Ft.
Method
GRAVITY
Topographic/Land setting
❑Ridge ®Slope ❑Valley CFIati
(check appropriate box)
Latitude/longitude of well localiat..
35D11.69W84D1.49W
(dcgnxs/minutes(seconds)
Latitude/longitude source:KIGPSDTop
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL, PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
(check box)
DEPTH DRILL
From To Formation Description
0' TO 10' BLACK DIRT
10' TO 20' CLAY 8 BOULDERS
20' TO 31' BLUE SLATE
31' TO 600' BLUE SLATE
phir map
L )
r
0
0
�.777
c (r
0
! rj
LOCATION SKETCH m
Show direction and distance in miles from at east
two State Roads or County Roads. Include j roaT-'-'
numbers and common road names.
0
I DO HEREBY CERTIFY THAT TRIS WELL WAS CONSTRUC'I ED IN ACCORDANCE Will! I5A NCAC 2C, WELL
CONSTRUCTLON STANDARDS, AND TJAT\A�OPY OF TIII REC9RDDII jS BEEN PROVIDED TO THE WELL OWNER
SIG LURE OF PERSON CONSTRUCTING TILE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service CeCtWr' Raleigh,
C I
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (1NDIV9DUAL)NAME (print)
CALVIN W. ROSE CERTIFICATION 0 3327
WELL CONTRACTOR COMPANY NAME ROSE'S WELL DRILLING
STATE WEI,L CONSTRUCTION PERMIT, ASSOCIATED WQ PERMIT, _
(if applicable) (if applicable) r--
282782
PHONE [phone]
1. WELL USE (Check Applicable Box): Residential 1 Municipal/Public ❑ industrial ❑ Agricultural ❑ IL?)
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
5145 HANGING DOG RD
County CHEROKEE
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: MAX O'DELL
Address 5145 HANGING DOG RD
(Street or Route No.)
MURPHY, NC
28906
City or Town State Zip Code
( 828 )_ 837-8455
Arca code- Phone number
4. DATE DRILLED 11-04-2003
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE. EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 84' FT.
(Use "+^ if Above Top of Casing)
8. TOP OF CASING IS 1 ET. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST AIR
10. WATER ZONES (depth): 260'
I. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 92 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 25
From To
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
6 1/8" SDR 21 PVC
Material Method
Ft. CEMENT GRAVITY
Ft.
Topographic/Land setting;
K)Ridge ❑Slope ❑Valley UFhat''
(check nppmptiate box)
Latitude/longitude of well locatipt (i
35010.21W84D3.07W f
(degrees/minutes/seconds)
Latitude/longitude source:IDGPSOTopo
(check box)
DEPTH DRILLI
From To Formation De cnp on
0' T080' BROWN SLATE
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Frotn To Ft.
From To Ft.
80' TO 400' BLUE SLATE
C
BLUE SLATE
o 0
w
0 a; '
zr
O m
--O
rp
\
73
LOCATION SKETCH
Show direction and distance in miles from aC2kast c
two State Roads or County Roads. Include the road`
numbers and common road names.
CJ
16. REMARKS:
I DO IIERERY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANC'E WITII I5A NCAC 2C, WELL
T A COPY OF THIS 'CORD IIAS BEEN PROVIDED TO TILE WELL OWNER
CONSTRUCTION STANDARDS, AN➢'CffA
J L ) - //-17/-0_3
NATURE OF PERSON CONSTRUCTING TIIE WELL DM E
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION # 3295
282781
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT,/
(if applicable)
I. WELL USE (Check Applicable 13ox): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
LANCE RD - HOLLYBERRY
County CHEROKEE
(Street Name, Numbers, Commtmity, Subdivision, tot No., Zip Code)
3. OWNER: ANNE MCKEEVER
Address P.O. BOX 314
(Street or Route No.)
MURPHY, NC
City or Town State
( 828 )_ 837-2217
Area code- Phone number
4. DATE DRILLED 10-23-2003
5. TOTAL DEPTH: 305
28906
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO RI
7. STATIC WATER LEVEL Below Top of Casing: 96 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST AIR
10. WATER ZONES (depth): 140'
II. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 62 Ft. 61/8"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
Method
GRAVITY
From To Et.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
i
Topographic/Land setting
❑Ridge ®Slope ❑Valley ['FlatI
(check appropriate box)
Latitude/longitude of well location,
3500.649 N H/8404.637 W
(degrees/minutes/seconds)
Latitude/longitude sourcc:KIGPS0Topogfaphkc map
(check box)
DEPTH DRILLI GTfU1es rtpLrarr-
L
6 .
From To Formation
0' TO 20' RED CLAY
20' TO 40' BROWN DIRT
40' TO 62' GRANITE
62' TO 305' GRANITE
n
or
'=o
LOCATION SKETCH cn
Show direction and distance in miles from a least c-,—
two State Roads or County Roads. Include t mgjroar
numbers and common Toad names.
ii 7triT m
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL W. S CONSTRUCT( PO IN ACCORDANCE WTHI 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THA"COPY OF II 'ORRYIT7 BEEN PROVIDED TO THE WELL OWNER
ERSON L'�ONSTjktkfTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2769¢•1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

282780
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION IS 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE t) [phone]
STATE WELL CONSTRUCTION PERM1T0 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 1 Municipal/Public ❑ Industrial ID Agricultural O',
Monitoring 0 Recovery 0 Heat Pwnp Water Injection ❑ Other O If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
BOULDER CREEK - CLAY DURRETT DR
(Street Name, Numbers. Community, Subdivision, Lit No., Zip Code)
3. OWNER: STEVE CROWE
Address 5510 HWY 64 WEST
(Street or Route No.)
MURPHY, NC
City or Town State
( 828 )_ 837-9199
Area code- Phone number
4. DATE DRILLED 10-28-2003
5. TOTAL DEPTH: 505'
28906
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO tKI
7. STATIC WATER LEVEL Below Top of Casing: 94 ET.
(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 2C .0110.
9. YIELD (gpm): 30 METHOD OF TEST AIR
10. WATER ZONES (depth): 420'
11. DISINFECTION: Type CHLORINE
12.
CASING:
Depth
Prom 0 To 112 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
61/8" SDR21 PVC
Method
GRAVITY
16. REMARKS:
Material
Ft, CEMENT
Topographic/Land setting
®Ridge OSlope ❑Valley ❑Flat]
(cheek nppmpriate hox)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopograpt(ic map i
(check box) ,__.__--- --_.
DL"PTH DRILLING LOG t t,_____
From To Formation 4escription_"__.___ _,._,
O'TO60' RED CLAY
60' TO 80' BROWN DIRT
80' TO 112'
112' TO 505'
BLUE SLATE
BLUE SLATE
O
,, r
77
+ r
C c..i
0
c
S a
CJ V:
LOCATION SKETCH ro
Show direction and distance in miles from at%ast o
two State Roads or County Roads. Include the road
numbers and common road names.
-5
uc5 )
1 DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI'FII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COP OF THIS R RD 1 BEEN PROVIDED TO THE, WELL OWNER
SIGNATURE OF PE
GTHE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- 1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION If 3295
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. piONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
282779
1. WELL USE (Check Applicable Box): Residential 181 Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
2276 HEDDEN RD
County CHEROKEE
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES KUNKEL
Address 7055 54TH ST., NORTH
(Street or Route Na.)
PINELLAS PARK, FL 33781
City or Taws State Zip Code
( 727 )_ 546-4109
Area code- Phone number
4. DATE DRILLED 11-01-2003
5. TOTAL DEPTH: 425'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top ofCasing: 100 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 ISA NCAC 2C .a118.
9. YIELD (gpm): 4 METHOD OF TEST AIR
10. WATER ZONES (depth): 380'
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 115
From To
From To
13. GROUT: Depth
From 0 To 20
Amount 100 PPM
Wall Thickness
Diameter or Weight/FI. Material
Ft. 6 1/8" SDR21 PVC
Et.
Ft.
Material Method
Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Slot Sizc Material
in.
in.
Material
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well locatioff_
I degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topo
(check box)
DEPTH DRILLIN
From To Formation D
0' TO 40' RED CLAY
40' TO 80' SAND
80' TO 115'
GRANITE
115' TO 425' GRANITE
0
0
0
Y
1
O -rn
i0
v n�
__o
.1
cs) >r
Show direction and distance in miles from mast E
two State Roads or County Roads. Include thteroae
numbers and common road names.
LOCATION SKETCH
16. REMARKS:
I DO HEREBY CERTIFY'IIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wllll I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIDY COPY OF. I,IIS RE ' RD IIAS BEEN PROVIDED TO TIIE WELL OWNER
V
w -rt�� /i^i'4)3
SIRUCFING THE WELL DATE
Submit the original to the Division of Water Quality, f,'roundwater Section, 1636 Mali Service Censer- Raleigh, NC
27699-1636 Phone No. [phone], within 31) days.
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION 0 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERIIIITN
(if applicable) (if applicable)
282778
PHONE a f828) 837-8008
a= —
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural 14_ 5;,
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use -'
2. WELL LOCATION:
Nearest Town: MURPHY
County CHEROKEE
ROCKRIDGE RD - MARY KING MTN
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KEN GALLOWAY
Address 33 RAVEN LN
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Code
( 828 )- 837-6083
Arco code- Phone number
4. DATE DRILLED 10-29-03
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use "f" if Above Top of Casing)
8. TOP OF CASING 1S 1 ET. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0119.
9. YIELD (gpm): 12 METHOD OF TEST AIR
10. WATER ZONES (depth): 480'
I I. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 51 EL 6 118" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT:
From 0
Depth Material
To 20 FL CEMENT
Method
GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land settirg
®Ridge ❑Slope ❑Valley QEft
(check appropriate box)
Latitude/longitude of well loc
3504.000N/8410.829W
Wrens/minutes/seconds)
Latitudc3ongitude source:KIGPSOTo
(check box)
DEPTH DRIL
From To Formation Description
0' TO 30' RED CLAY
30' TO 51' BLUE SLATE
51' TO 505' BLUE SLATE
0
c
o`
cam
O E
O
3
fV
LOCATION SKETCH w 5
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
CO Cl)
r-r
c,
1 DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE. WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND Tt1AT PY OF TLlRS {2ECQRp IIAS BEEN PROVIDED) TO'FIIE WELL OWNER
to '�9-03
SIGN
S
TING TIIE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD 2 8 2 4 01
North Carolina - Department of Enviromncnt and Natural Resources - Division of Water Quality GroundI tter Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) .�aVy105 X� IA S OF\ - Pi ERR a I L937-� Y
WELL CONTRACTOR COMPANY NAME M,\1prt WI t,JPl1 (41 A9SSOCIATED WQPERhiITN
STATE WELLCONSTRUCTION PERMIT,/)
if npplicable
ifa p liliracabic) -
1. WELL USE (Check Applicable Box): Residential fY Municipal/Public ❑ Industrial 0 Agricultural 0 !,
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use__-
2. WELL LOCATION: CountyC�PfC+ Pe
Nearest Town^t�
(Street ame Numbers, Community, Subdivision, Lot No., Zip Code)
0 2 H�pxC�
3. OWNER: \ • _►aaa. ___
Address i-1tr-)
City or Town State Zip Code
( )-
Ares code- Phone number 23
4. DATE DRILLED
5. TOTAL DEPTH: 7US
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO G7-
7. STATIC WATER LEVEL Below Top of Casing: i
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S I Fr. Above Land Surface.'
*Top of cuing terminated atior below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
METHOD OF TEST iL
9. YIELD (gpm):_—
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
Fron
ts_To �D
From To
From _ To
13. GROUT: Depth
From —To 020
From To
14. SCREEN:
rwVu
From
15. SAND/GRAVEL PACK:
Depth
From To
From To
�h Amount lr
Wall Thickness
Diameter or Wciglu/Ft. Material
7)/C
16. REMARKS:
I DO HEREBY CERTIFY TI IAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITii I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIE WELL OWNER
Depth
To
To
Ft.
Ft.
Material
Ft. "4
Ft.
Diameter
Ft. in.
PI n.
Ft.
Ft.
r
Topographic/Land setting
DRidge ft8lope ❑Valley ❑Pint:1
(check appropriate box)
Latitude/longitude of well locati@ S=_
(degrees/minutes/seconds) ipn
Latitude/longitude source:❑GPS❑Topographic nra—
(check box) `l``
tciL""t� 1,00
atiou Uccc^ption
Method
Slot Size Material
in.
Size Material
pEPTIt
From To
C
o_
t nc ATl� �_ ON SKETCH
Show direction and distance in miles from at ten
two State Roads or County Roads. Inc14 theit3ad
numbers and common road names.
Ca o
Lp z
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Senlce CGVJrI - REVgh, C
27699-1636 Rhone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD 282400
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater
ATr Sec
Mt on
WELL CONTRACTOR (INDIVIDUAL) NAME (print)' 1^Kt'IP S Q., l^�`l5n`^
Can WELL CONTRACTOR COMPANY NAME YV1,N�P.( 1 A7c O�f 11n PHONE A fi1a" 7=-- 7 ERMITM
STATE WELL CONSTRUCTION PERMIT, ASSOCIATED WQ ifn licabP
if a licable
1. WELL USE (Check Applicable Box): Residential I3---Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Putnp Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting i
❑Ridge Ll81ope ❑Valley Lot aF I
(check appropriate boy) ;',k.
Latitude/longitude of well location =-
2. WELL LOCATION:
NearestTown: 0 4ri County/ \AQrok0op
cr pt e. N
(Street Name, Numbers, Community, Subdivisioa,Lot No., Zip Code)
3. OWNER:`; bras 1-(e vkeen 0.
Address `i V--
City of To
State Zip Code
( )-
Area code- Phone number 2y- O3
4. DATE DRILLED
5 TOTAL
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ®-
-
r
7. STATIC WATER LEVEL Below Top of Casing: i
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 s
variance In accordance with ISA NCAC 2C .0118. n
9. YIELD (gpm): 2O METHOD OF TESTALL...—_
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
ham— Amour'Thickness
Thickness
Diameter or Weight/Ft. Material
Pronu..Q__To 1l l Ft. 6,OS _ From To_ To Ft.
From To Ft.
13. GROUT:['� Depth M t vial
rr Frot_JG— To 212r Ft.-
To Ft.
Diameter
Ft. in.
in.
t ti
From_
14. SCREEN:
From
From
Depth
To_.
To Ft.
15. SAND/GRAVEL PACK:
Depth
From To Ft..
From To Ft.
Size
//,»e// #cQ
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Tope€
(check box)
r'G
PEPTII DRiL ...
rn:iL-
From To gn9tiouDcz_riftion
�- 0
r `0'
Method
Try
Slot Size Material
in.
in.
Material
1
Show direction and distance in miles ffoak m east
two State Roads or County Roads. Inc rile t o woad
numbers and common road names.
ON
(( ',sags ie.
QpM
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITI! 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TII WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceentiri REVgh, C01
276g9-1636 Phone No. [phone], within 30 days.
r
rapine .t4

WELL CONSTRUCTION RECORD
North Carolina - Department of Enviromncnt and Natural Resources - Division of Water Quality Groundwater
rouCERTdw ter SeN Ht on J
otn�vi
WELL CONTMCTOR(INDIVIDUAL)NAM1TE (print) PHONE # r`-''y 457'�i4I
WELL CONTRACTOR COMPANY NM1F, v"i t � It ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT# i(y,jWQ
if a r elicable
le
1. WELL USE (Check Applicable Box): Residential Ga Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pwnp Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION: County +P :fP
Nearest Town:
(Street em<, Numbers, Community, Subdivisir,:y Lot No., Zip Cale)
i0 ✓t Alfa.; 5
State Zip Code
3. OWNER:C
Address ti
City or Town
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 1r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 0-
7. STATIC WATER LEVEL Below Top of Casing: <n' Ff.
(Use "+" if Above Top of Caning)
8. TOP OF CASING IS I Fr. Above Land Surface'
Top of casing terminated attor below land surface requires a
varlance In accordance with 15A NCAC 2C .0118. n,
9. YIELD' m): p2S METHOD OF TEST Ili
10. WATER ZONES (dcpth) - -
11. DISINFECTION: Typel^ } — Amount i L.`
12. CASING: Wall Thickness
Material
Front _i�._ To 1120��-
282399
Topographic/Land setting
[Ridge ❑Slope ❑Valley ❑ tat-]
(check appropriate box)
Latitude/longitude of well locatidn
(degrees/minutesseconds)
Latitude/longitude source:❑GPS❑Topog
(check box)
pir;L=—
Fornlatiou Dcr-^ration
GC
DEPTIi
From To
)�7 ,2 ��
Depth Diameter or We ght/Pt.
From To Ft. —
From To Ft. —
13. GROUT: Depth Material
From_ 12 __ Tom---. Ft.
From To Ft.
14. SCREEN: Depth Diameter
Frorn To Ft. in.
Ft. in.
Frorn To
15. SAND/GRAVEL PACK:
Depth
From To_.___
From To
Ft.
Ft.
Method
Slot Size Material
in.
in.
Size Material
i OCATION SKETCH -D
Show direction and distance in miles rRRr
two State Roads ur County Roads. Int;Hlds
numbers and common road nanteo. rid
/le 4�o =tfee
vOexer
Le/Cc
a g8st
load
16. REMARKS:
LL
I DO N TRUCY CERTIFY ARDHAT , THISWELL
THAT A COPY OF THIS RECORD HASEEN PROVIDED TO TUE WE L OWNER
CONSTRUCTION STANDARDS,
2
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Centteeri Raleigh,
C
27699-1636 Phone No. [phone], within 30 days.
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater
SecNik on
WELL CONTRACTOR (lND1VIDUAL)NAME (print) J-IWa-�� ^' ('� PRONE # (� ). 3r-`�i�
WELL CONTRACTOR COMPANY NAME 011 PC LOC_ df
ASSOCIATED WQ PERMIT#
STATE `ye_ia. CONSTRUCTION PERMITS/ (i f appljcable)
(ifanpljcablc) ..
282398
1. WELL USE (Check Applicable Box): Residential ®rMunieipaL'Public ❑ Industrial 0 Agricultural
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, Li;: Use
2. WELL LOCATION:
Nearest Town:_1
1,WI
(Street Name, Numbers, Cotmnunity, Subdivision, Lot No., Zip Code)
° Tr. bal OD\S-
County C tleCCI P P
3. OWNER:
Address �() DX �jy1
City or Town
( )-
Area code- Phone number
4. DATE DRILLED
5 TOTAL DEPTH' I (o5r
leek
(Street or Route No.)
2E11(1
State Zip Code
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 3Et 1 FT.
(Use'•+•• if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
varianceIn accordance with is METHOD OF TESTA e
CAC 2C .0118.
9. YIELDIELD(gpm):
10. WATER ZONES (depth):
11. DISINFECTION: Typeh‘fyl tat�P�S
12. CASING:
Depth Diameter
Front To k t
From To
Ft.
Front To_ Ft.
13. GROUT: DIPMat riai Method
S -)t P SSW (c'.
From. __T0 fi ` Ft. port -land
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft.
Amount 15
Wall Thickness
or Weight/Ft. Material num
From To Ft.
Topographic/Land settin
DRidge ❑Slope (alley
(check appropriate box) rE..
Latitude/longitude of well loc4twn 1
g15tvS121, QB4;oo; Z9 I —
(degreeslminuteiseconds) -r-
Lalitude/longitude source:❑GPS❑Toppgraphic kip_ j
(cbeck box)
��V 1f�c..fi+)(J
Formation cz_^Ption
it
:r f
DEPTH
From To
3rY - I(DSi
_Jl ONShow direction and distance in miles Crgrn aE3east
two State Roads or County Roads. Inctr;de the36ad
ers and common road names. C U
N
W
0
USiI ��ScuL
16. REMARKS: -
1 O HEREBYN CERTIFYSTANDARDS,
THAT ANDHIS THAT A COPY OF THIS ELL WAS CONST IED IN ACCORDANCE RECORD HAS BEEN Pic.OVlDFD TO r E WELL OWNER
CONST•UCTIONO3
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenter, REVgh, C01
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural RCSOurces - Division f Water Quality Groundwater CERTIFICATION MSection
INDIVIDUAL) NAME (print) »��S Yy
WELL CONTRACTOR(
WELL CONTRACTOR COMPANY NAME � +y_ 1k of
STATE WELL CONSTRUCTION PERMIT"
if applicable)
1. \VELL USE (Check Applicable Box): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
Midge ❑Slope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
tJ feo1 r " z9 � gse s8'rFz" ,;,
-_
(degrees/minutes/seconds)
28229'7
PRONE # 1f111.2997
2. WELL LOCATION: NearestT wn:AC an CountyS/�
\\P&'PN
(e
(Street Name,Numbmber, Community, Subdivision, Lot No., Zip Code)
3. OWNER: J
Address `z of
City or "[own
(.—)
Area coo,'e- Phone ^„mhrr
4. DATE DRILLED LJ:212 l`2Z
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO IL1-
7. STATIC WATER LEVEL Below Top of Casing: _isit—FT•
(Use "+" if Above Top of Casing)
FT. Above Land Surface'
8. TOP OF CASING IS _L_---
•Top of casing terminated atfor below land surface requires a
vaordaaccordancewith 15 METHOD OF TEST rQ -
NCAC 2C .0118.
9. YIELDIELD (gpm):
10. WATER ZONES (depth):
11. DISINFECTION: Type_
12. CASING:
ASSOCIATED WQ PERMIT"
(if applicable)_,_
State Zip Code
Depth Diameter
Fronui__To-J-X—Ft.( :S
From To Ft.
From To Ft.
13. GROUT: Depth M teria
Frorn_D—_ T o—aa-t— Ft.
From
14. SCREEN:
From
To Ft.
Depth
To
From To
15. SAND/GRAVEL PACK:
Depth
To
To___
From,
From
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCT ED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
EL OWNER
Ft. in.
Ft. in.
Size
Ft._
Ft._
Slot Size
in.
in.
Material
n
Latitude/longitude source:❑GPS❑Topographic nap
(check box)
r INr; r oci
DL'PTli �r •,.
From To Fonnanon Dc:;^^ration
1,2
Amount
Wall Thickness
or Weight/Ft. �Mfaterial
SDF.2( . ,C. _.
Method
[)rem
Material
t OCAT�� ION SK> ► D
Show direction and distance in miles fit ateast
two State Roads or County Roads. Inchide wad
numbers and common road names. r'..
sr
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenteri REVgh, NC
27699-1636 Phone No. [phone], within 30 days.
DATE
M"tL t
L

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater
Section ion/D�I
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
11 PHONE N fsJG) `<3T-a%
ASSOCIATED WQ PERMITH
----- if appticableZ
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMITS/
if Lipp cable
1. WELL USE (Check ApplicablelII : Residential
er EYunion O pa/PublicOther 0 l Industrial1l❑se Agricultural 0
Monitoring 0 Recovery ❑ at
Pump
282395
2. WELL LOCATION:
Nearest Town:
CountyQ'_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
City or To
n
State r Zip Code
Area code- Phone number
4. DATE DRILLEDIELLC -Cz
5. TOTAL DEPTH:12S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO L
7. STATIC WATER LEVEL Below Top of Casing: _ r _—FT•
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l FT. Above Land Surface
*Top of casing terminated at/or below land surface requires a
variance In accordance with IS METHOD OF TEST to I Q -
9. YIELD (gprn):
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
From
From To _
From _ To
13. GROUT: Depth
From__(:)___ To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To
1 .thie—\>5-- Amount 1
Wall Thickness
Diameter or Weight/Ft. Material
_5'QV?1 +QC ---
setting;
❑Ridge ❑Slope Ii Talley UyElaSi
(check appropriate box) i
Latitude/longitude of well locatjorr„ 1
1,) °St'yc" iwtit' 2`I `- f
(degrees/minutes/seconds) .
Latitude/longitude source:OGPSOTopo6iptii
(check box)----�
Formatlas' Description
Ft
Ft.
Material
;vletI ad
___,,asaL Ft. nnril -- St_tie —
Ft.
Diameter Slot Size Material
Ft. in. in.
Ftin. in.
DEPTH
From To
ip- Ir
Size Material
Ft.
Ft.
r^
0
r _ _
I t7 ATION SKETCH -'0
Show direction and distance in miles ram aElE5st
two State Roads or County Roads. Inca de Qi4 road
N
numbers and common road names. coo
An ;fried;
a
16. REMARKS:
I DO IIEREBY CERTIFY THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Ceenteri REVgh, C
27699-1636 Phone No. [phone], within 30 days.

2. WELL LOCATION: II
Nearest Town:.L " County h e Cb )�t�
II�oL�t� T Qr
(Street Name, Numbers, Community, Subdivisiro, Lot No., Zip Code)
jtin i-ken(tt lk
3. OWNER:
Address
l>ki \C
City or wn
State Zip Code
Arncode- Phone numbm/6A.. •�
4. DATE DRILLED
5. TOTAL DEPTH: 5"JS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
sing:
7. STATIC WATER LEVEL Below
UsTop e °ifAboveTFT.
Top of Casing)
8. TOP OF CASING 1S / 7Z—FT. Above Land Surface
-.,.re.e requires a
*Top orcasing terminated aoor uri✓d :- �- ----
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): _L METHOD OF TEST i r_ % ----
10. WATER ZONES (depth):
11. DISINFECTION: Type _e li�—
12. CASING: Depth Diameter
Fron Ft
From To
From To Ft.
13. GROUT' Depth Material Method
Slot Size M
in.
in.
Amount
Wall Thickness
or Weight/Ft. Material
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality CERTIFICATION Ntioon
WELL CONTRACTOR (INDIVIDUAL) NAME (print) r tl 1/fei��Gl PIIONE If2 Y
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMITS
STATE WELL CONSTRUCTION PERMITS/i(a licable
if licable
1. WELL USE (Check
Applicable Box)' Residential ElfMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 t-leat Pump Water Injection ❑ Other 0 if Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
i SY
t� C )23
(de gtees/mi nutes/sxom la)
Latitude/longitude source:❑GPSCITopographic map
(check box)
RILL1^12,t JG
Formation Description
282393
To_ FL r tl ii 2i -Y�=--
From
14. SCREEN:
From
From
15. SAND/GRAVEL PACK:
Depth
To
From.
From
Ft.r ^
To Ft.
Depth Diameter
To Ft. in.
To Ft. in.
Size Material
Ft.
To Ft.
DFpI?PTII
From To
r
1 OCATION 6 T CI4 v R;
Show direction and distance in miles fra'm at feast
two State Roads or County Roads. Inc1We th%t,iad
numbers and common road names. r o
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY DE THIS RECORD HAS BEEN PROVIDED TO THE
WELL
OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenterl REVgh, C01
27699-1636 Phone No. [phone], within 30 days.
r

WELL CONSTRUCTION RECORD 2 g 2 3 9 2
North Carolina - Department of Enviromnent and Natural Resources - Division of Water Quality
Grounu! dCATIONa Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
,,W-V/Lr W€1 I �i If , PHONE. N 8, % .2 n 7
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMIT"
if a. licable
STATE WELL CONSTRUCTION PERMIT"
if a..licable
1. WELL USE (Check Applicable Box): Residential O--Iclunicipal/Public ❑ Industrial ❑ Agricultural
Monitoring ❑ Recovery
❑ Heat Pump Water Injection ❑ Other ❑ If Oilier, List Usc
2. WELL LOCATION: Y G%erod'e E
Nearest Town: %%%___ . fr — County
?19= a aid,
(Street Name, Numbers, Community, Subdivisica, Lot No., Zip Code)
3. OWNER: %7n grarv/y
Address a20
City or row
State Zip Code
(-)
Area code- Phone number
4. DATE DRILLED /0 -, O j 3
5 TOTAL DEPTH• Jvo '
6 DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q-
7. STATIC WATER LEVEL Below Top of Casing: /A C FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 2- Fr. Above Land Surface`
*Top of casing terminated at/or blow land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 3 METIIOD OF TEST /5/ /-
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
t From To d
From To
From To
13. GROUT: Depth Material
From_ O To�._ Ft. drf
From To Ft.
14. SCREEN: Depth
From — f o
From To
15. SAND/GRAVEL PACK:
Depth
To
To
// re(
Diameter
r.
Amomlt i(c,"
Wall Thickness
or Weight/Ft. Material
SD2.Zl_ /14/6-
From.
From
Ft.
Ft.
Topographic/Land settink
❑Ridge ❑Slope ❑Valley ClFl$
(check appropriate box) I
Latitude/longitude of well localtion
.4.2f' 02'/0.t .vfV °Y' 'r?`''
(degrees/minutes/seconde) �.
Latitude longitude source:❑GPS❑TopOrap uc n�
(check box)
DRiLrI—
Fotmatiou.iDcsz iption
pEPTII
From To
-s-t.)
Method
cfl✓ C
Diameter Slot Size Material
Ft in. in.
Ft. in. in.
Ft.
Ft.
Size Material
Sd.d
c
W o
C
SC ��I 2-`�'-;
Show direction and distance istance in miles fro4,m,, at ICA'S
two State Roads or County Roads. Inclu a thtrioad
cn
numbers and common road names. co ere
IV
o
16. REMARKS:
I DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
/O _/v-d?
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
NC
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service CGWrl RRaaleigh, N001
27699-1636 Phone No. [phone], within 30 days.
OJ

North Carolina - Department of Environrnent and N
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
le r
STATE WELL CONSTRUCTION PERMIT!!
if applicable)
WELL CONSTRUCTION RECORD
ural Reso rocs - Division of Water Quality - Groundwater Section
re-CERTIFICATION rY �LO
PHONE M f f?2—/?
ASSOCIATED WQ PERMIT!!
if applicable)
282391
1. WELL USE (Check Applicable Box): Residential L1---MunicipalPublic ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
DRidge ❑Slope ❑Valley ❑Flat
(check appropriate box) I
Latitude/longitude of well location i
NJSe/0 65-.6' wnAYOA �A-
(degrees/m i nutes/seconds)
GPS❑To ograp ric n sp
2. WELL LOCATION: /(
Nearest Town:_.2��
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: •Taf0A C% -MkrS
Address
County Lff24i Z
City or Tower StateZip Code
lam-.
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: 3AS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO U
7. STATIC WATER LEVEL Below Top of Casing: —FT•
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): /S' METHOD OF TEST A
10. WATER ZONES (depth): 3 2S
11. NFECT!ON: Type (/ Amount KV
12. CASING:
Depth
From To /3j Ft.
From To Ft.
From* To Ft.
13. GROUT: Depth
FrornQ—To2& _.Ft.
From To Ft.
14. SCREEN: Depth
Fror^ To
From To
15. SAND/GRAVEL PACK:
Depth
From To
Ftom To_
Wall "I1,ieknesa
Diameter or Weight/Pt. ivthtc ia!
6.zs' soezl Oy
ntc//�rir_rat clhod
Q/ «ia /eJSd.^
Dimnctcr
Ft. in.
Ft. in.
Size
Ft.
Ft.
Slot Size
in.
in.
Material
Material
Latitude/longitude source.❑ P
Wand
From To
(check box)
DRiLLINit r OG
Formation Description
I O ATION SKETCH '� >C3
c
Show direction and distance in miles from at Past
two State Roads or County Roads. Inch a thNcgad
CO
numbers and common road names.
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI I I5ANCAC 2C, WELL
CONSTRUCTION STANDARDS, AND,,THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TITS WELL OWNER
dVi � SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenteeri REVgh, C01
27609-1636 Phone No. [phone], within 30 dnys.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION if 3295
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ 1'ERMITH
(if applicable) (if applicable)
282376
1. WELL USE (Check Applicable Box): Residential 181 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
UPPER PEACHTREE RD.
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JIMMY CARROLL
Address 1162 ANDREWS RD
(Street Or Route No.)
MURPHY, NC
28906
City or Town State Zip Code
( 828 )- 837-4298
Area code- Phone number
4. DATE DRILLED 10-18-2003
5. TOTAL DEPTH: 125'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 15 ET.
(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 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST AIR
10. WATER ZONES (depth): 56'
I I. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING:
Depth
From 0 To 36
From To
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Pl.
14. SCREEN: Depth Diameter
From To Pt. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 61/8" SDR21 PVC
Ft.
Material
Ft. CEMENT
Method
GRAVITY
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
n0
'I opographic/Land setting is E
❑Ridge ❑Slope IEValley 0 1at
(check appropriate bon) u
13:-
Latitude/longitude of well locatio
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogrmap
(check box)
DEPTH DRILLINI',0
From To Formation D=.crip ion
0' TO 36' OVERBURDEN
36' TO 56' GRANITE
56' TO 60' WEATHERED ROCK
60' TO 125' GRANITE
O
W
LOCATION SKETCH
Show direction and distance in miles from at least o=
two Stale Roads or County Roads. Include thehroad c:
numbers and common road names. 'o m
3 fir^,
cn
r1
fa
N
I DO HEREBY CERTIFY THAT THIS
CONSTRUCTION STANDARDS, A
L WAS CONSTRUC'TEI) IN CCORDANC'F WI fll I5A NCAC 2C, WELL
AT A COPYOP;I\I11S RE. R HAS BEEN PROVIDED TO TIIE WELL OWNER
0
SIGNATUI&OF PE C2UCHNG TIIF WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- 1 REV. 07/2001

282375
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W'F.LI. CONTRACTOR (INDIVIDUAL) NAME (print)
LARRY F. JONES CERTIFICATION q 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
VANDORA SUITS RD, TUTTLE LN
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOSEPH REYNOLDS
Address 214 REDDEN RD
(Street or Route No.)
MURPHY, NC
City or Town State
( 828 )- 837-0286
Area code- Phone number
4. DATE DRILLED 10-22-2003
28906
Zip Code
5. TOTAL DEPTH: 605'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C.0111i.
9. YIELD (gpm): 30 METHOD OF TEST AIR
10. WATER ZONES (depth): 550'
11. DISINFECTION: Type CHLORINE
12. CASING:
From 0
Depth
To 112
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
Frorn To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sim Material
From To It.
From To Ft.
16. REMARKS:
Material Method
pt, CEMENT GRAVITY
n
Topographic/Land setting
❑Ridge IDSlepe OValley OFl E;
(check appropriate box)
Latitude/longitude of well location
(deuces/minutes/seconds)
Latitude/longitude source:OGPSOTopogra
(check box)
DEPTH DRILLING
From To Formation Dc
0' TO 90' RED CLAY
90' TO 112' BLUE SLATE
112' TO 605' BLUE SLATE
lap
IOG
cription
GRANITE
LOCATION SKETCH
Show direction and distance in miles from at43asl two State Roads or County Roads. Include Ihs road-
numhhrs and common road names.
tx-CAtt If)
-e3 Se
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT AAyOPY OF TitRECORS BEEN PROVIDED '10 THE WELL OWNER
-03
SIGNA" URE OF
TING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

28237'4
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
R'ELI, CONTRACTOR (INDIVIDUAL) NAME (prinQ
LARRY F. JONES CERTIFICATION H 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PIIONE q [phone]
STATE WELL CONSTRUCTION PERMIT('
ASSOCIATED WO PERMITH
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Usc
2. WELL LOCATION:
Nearest Town: MURPHY
County CHEROKEE
WOLF MTN. ESTATES
(Street Name, Numbers. Community, Subdivision. tnt No., Zip Code)
3. OWNER: JIM & DIANE MEDAL
Address 1401 SW 53TH LANE
(Street or Route No.)
CAPE CORAL, FL 33914
City or Ton State Zip Code
( 239 )_ 549-5555
Area code- Phone number
4. DATE DRILLED 10-09-2003
5. TOTAL DEPTH: 907'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO VI
7. STATIC WATER LEVEL Below Top of Casing: 753 ET.
(Usc "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
`Top of easing terminated at/or below land surface require a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): ---- METHOD OF TEST AIR
10. WATER ZONES (depth):
II. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 60 El, 6 1/8"
From To Ft.
Iron) To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.
Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
From To Ft.
14. SCREEN: Depth Diameter Skit Size Material
From To Pl. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16.REMARKS:
c
'1 opographic/Land setting
®Ridge ❑Slope ❑Valley ❑Fats.
(check appropriate box) S,
Latitude/longitude of well location^ r:
`:i :r
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topogr
(check box)
DEPTH DRILLIN
From To Formation De
0' TO 15' BLACK DIRT & B
15' TO 60' QUARTZ & GRA
60' TO 907' GRANITE
O
W
o
0
0
1 0 ti
r—
LOCATION SKETCH -o m
Show direction and distance in miles from at I€st ram-- N
two State Roads or County Roads. Include theYoad—
c-
numbers and common roaanaamcs. J o
1 DO HEREBY CERTIFY TI(AT THIS WELL WAS CONSTRUCT E.D IN ACCORDANCE WIIII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI),A'f A COPY OF TI11S RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
G" Jo c 05
SI(9N ATUR F PERSON 1RUCTI No IIH WELL DATE
l
Submit the original to the Division of Water Quality, Groundwater Section, I63611i al Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

282373
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
LARRY F. JONES CERTIFICATION a 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PIIONE a [phone]
STATE WELL CONSTRUCTION PERMITI
(if applicable)
ASSOCIATED WQ PERMIT/
(if applicable)
I. WELL USE (Check Applicable Box): Residential ® MunicipaVPublic O Industrial ❑ Agricultural O
Monitoring O Recovery O Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
HWY 294
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot Nei_ Zip Code)
3. OWNER: CHEROKEE COUNTY RESCUE SQUAD
Address P.O. BOX 602
(Street or Route No.)
MURPHY, NC
28906
City or Town State Zip Code
( 828 )_ 644-5114
Area code- Phone number 20' TO 52'
4. DATE DRILLED 10-17-2003
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 45 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated actor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD (gpm): 1 METHOD OF TEST AIR
10. WATER ZONES (depth): 80'
-I'opographic/Land setting . `.
❑Ridge ®Slope ❑Valley CjFl4t
(check appropriate box)
Latitude/longitude of well locat QU"
3502.346N/8408.613W
(degrees/minutes/seconds) ;--
Latitude/longitude source:®GPSOTopo Pit c map
(check box) m __
DEPTH DRILLII G LOG , c
From To Formation
0' TO 20' RED CLAY
I I. DISINFECTION: Type CHLORINE
12. CASING:
Amount 100 PPM
Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 52 Ft. 6 1/8" SDR 21 PVC
From To Ft.
From To FL
13. GROUT: Depth Material
Prom 0 To 20 rt. CEMENT
Method
PUMPED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL
From To Ft.
16. REMARKS:
52' TO 505'
GRANITE
GRANITE
O
O
C
LOCATION SKETCH 2
Show direction and distance in miles from at leastD c
two State Roads or County Roads. Include t roaW
numbers and common road names. rn
CJ rn-,
0
/a j/ jt-{ E S
l DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TI tT A COPY OF TIIIS :CORD IIAS BEEN PROVIDED TO THE WELL OWNER
/o —/ 7' --o
NSTRUCIING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

282372
WELL CONSTRUCTION RECORD
North Carolina - Department of Enviromnent and Natural Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) NAME (print) CALVIN W. ROSE
WELL CONTRACTOR COMPANY NAME ROSE'S WELL DRILLING
- Groundwater Section
CERTIFICATION (3327
PHONE, IS [phone]
STATE WELL. CONSTRUCTION PERMIT(' ASSOCIATED WQ PERMIT(
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El MunicipaUPublic ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
County CHEROKEE
LIBERTY CIRCLE - HWY 294
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PAUL & SRAH GREEN
Address 112 COUNTY RD. 177 - APT. A
(Street or Route No.)
ATHENS, TN
37303
City or Town State Zip Code
( 423 )_ 649-2918
Area code- Phone number
4. DATE DRILLED 10-30-2003
5. TOTAL DEPTH: 200'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO KI
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface`
*Top of casing Ierminaled at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (pm): 17 1/2 METHOD OF TEST AIR
10. WATER ZONES (depth): 75' - 2 1/2 GRM
195'- 15GRM
I I. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 491/2 Et. 6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 EL CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Topographic/Land setting
®Ridge ❑Slope ['Valley OF
(check appropriate box)
Latitude/longitude of well locatio
35 / 7.15N / 84 / 16.89W
(degrees/minutes/seconds)
Latitude/longitude source:KIGPS['Topo
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' T049 1/2' SET CASING
49 1/2' TO 200' SLATE & LIMESTONE
St0
%ic map 1
CD -
LOCATION SKETCH w r._
•
Show direction and distance in miles from leas iT)
two State Roads or County Roads. Include:Wee roadii;
numbers and common road names. I '= = Cc71
q-C
•
N
J
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE. WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T \A PY OF TI�C�CORI) I S BEEN PROVIDED '1`�iE WELL OWNER
SIG RE OF PERSON CONSTRUCTING TIIE WELL • DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

282371
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
LARRY F. JONES CERTIFICATION # 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 181 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
HWY 294 - HOLLY RD
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MIKE & JANE BYRNES
Address 1171 HILL TOP RD
(Street or Route No.)
MURPHY, NC
City or Town State
( 828 )_ 644-9666
Area code- Phone number
4. DATE DRILLED 10-30-2003
28906
Zip Code
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES D NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 ET.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST AIR
10. WATER ZONES (depth): 460'
II. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Et. Material
From 0 To 77 Ft. 6 1/8" SDR 21 PVC
From To Ft.
From
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
To Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Slot Size Material
in.
in.
16. REMARKS:
Topographic/Land scttin
®Ridge ❑Slope ❑Valley ICTCIi
(check appropriate box) • '
Latitude/longitude of well loc‘tiioxi
3504.000N/8410.829W 1._.`_1.�
(dcgrecs/minutcs/seconds) _ L
Latitude/longitude source:KJGPSDTop ;P a
(check box)
DEPTH DRILL NG LOG
From To Formation
O'TO20' RED CLAY
20' TO 60' SAND
60' TO 7T
GRANITE
escnphon
7T TO 505' GRANITE
r..)
s•C
1
LOCATION SKETCH
Show direction and distance in miles from at Ica�
two State Roads or County Roads. Include the road
numbers and common road names. ••
r)
toeS-f
11)0 IIEREf3Y CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI'fit I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TER— COPY OF 71IIS RF ORD IIAS BEEN PROVIDED TO TILE WELL OWNER
SIGNATURE ' PERS CO RUCTING HIE, WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

282330
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)
IS • —Ca—MS CERTIFICATION it mod/13S
WELL CONTRACTOR COMPANY NAME WE55Vu tE' \$fl 1---Q . -4 t•1C PHONE # 3 = 1155
STATE WELL CONSTRUCTION PERMIT# - ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential 11—/ Municipa1Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCAT
Nearest, Town:
County
(StTea4ttamt umbers, Communil�, Subdivision, Lot No., Zip Code)
3. OWNER:
A•dress
City o
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YESR NO 19/
7. STATIC WATER LEVEL Below Top of Casing: `8J FT.
1 (Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordan with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD1OF TEST
10. WATER ZONES (depth): �?�s
Zip Code
kit DEPTH
gjbs From To
t-il
NJ' 3 W'
11. DISINFECTION: Type }FTi,
12. CASING:
tk, Di ter
From_ an Ft. ('r4-It
From To Ft.
From To Ft.
13. GROUT: Depth M4 vial
.%AtTt
From D To 31 FLQ
From To
Ft. l
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount
Wall Thickness
or Weight/Ft. c4,7ela1
Slot Size
Meth
Material
in.
in.
Size Material
opographic/Land setting
dge ❑Slope ❑Valley Mat
appropriate box)
Latitude/longitude of well Iota tipr%
(degrees/minutcs/seconds)
Latitude/longitude source:❑GPS❑Topo graphic m�
(check box)
DRILLING LOG
ForinAtion Description
IV
LOCATION SKETCH -O
Show direction and distance in miles from akliast
two State Roads or County Roads. Include the ro
numbers and common road names.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL q� CONSTRUCTION STANDARDS,` COPY O
i
THIS RECORD HAS BEEN PROVIDED TO THE , • �/CO Ol7
€434.9
SIGNATUI PERSON CONSTRUCTING THE WELL D TE/
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) TARRY F. JONES CERTIFICATION 8 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMAPANY, INC. PHONE 8 f 828) 837-8008
ASSOCIATED WQ PERMIT# 1
STATE WELL CONSTRUCTION PERMIT# (if applicable) (if applicable) f
it
I
I. WELL USE (Check Applicable Box): Residential I MunicipaUPublic 0 Industrial 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
SNAP - ON DRIVE , 1ST LEFT TO SHOP
(Street Name, Numbers. Community, Subdivision, int No., Zip Code)
3. OWNER: WELLS CONTRACTING
Address 391 DEER HILL RD
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Cale
( 828 )- 342-3251
Arca code- Phone number
4. DATE DRILLED 12-22-03
5. TOTAL DEPTH: 707'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 42 ET.
(Use "r" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top or casing terminated actor below Land surface requlrer a
variance in accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): 3 METHOD OF TEST AIR
ID. WATER ZONES (depth):
I I. DISINFEC-IION: Type CHLORINE
Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 51 Ft. 6 118" SDR 21 PVC
Front To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Et. in. in.
Front To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
284241
Agricultural 0
Topographic/Land setting
❑Ridge ®Slope OValley ❑flat l
(check appmprime box) ..i
Latitude/longitude of well location- -
(degrces/minutes/seconds)
Latitude/longitude source:OGPSOTopographictrap- _.
(check fax)
DEPTH DRILLING LOGr---
From To Formation Description
0' TO 20' SANDSTONE
20' TO 51' SLATE
51' TO 707' SLATE
c
0
r
K
O
075
Z Qrn
LOCATION SKETCH =It'
Show direction and distance in miles from at Last �rn rn
two State Roads or County Roads. Include tg,roargc
numbers and common road names. 3 �
o CO=
rn
CO -n-t
IV o
16. REMARKS:
1 DO lIERliBY CERTIFY THAT THIS WELL WAS CONSTRUCIED IN ACCORDANCE,SDW ITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TUAT A COOS OF THIS RECORDIl/="'.EN PROVIDED TO THE WELL OWNER
.✓Y- t-" 1, t4 _ /2-2)-13'e)
SIGNATURBOF PE
G THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center • Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

283508
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION',
3295
PHONE [phone]
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC.
STATE WELL CONSTRUCTION PERMIT', ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 181 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
157 MISSION RIDGE RD
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: RICHARD KINSEY
Address 270 THUNDER RD
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Code
( 828 )- 837-5407
Area code- Phone number
4. DATE DRILLED 12-18-2003
5. TOTAL DEPTH: 545
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO RI
7. STATIC WATER LEVEL Below Top of Casing: 30 ET.
(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 ■
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1/2 METHOD OF TEST AIR
10. WATER ZONES (depth): 200'
11. DISINFECTION: Type CHLORINE
12. CASING:
From 0
From To
From
GROUT:
Front 0
Amount 100 PPM
Wall Thickness
Depth Diameter or Weight/Ft. Material
To 140 Ft. 6 1/8" SDR 21 PVC
To
13. Depth
To 20
Ft.
Ft.
Material
Et. CEMENT
Method
GRAVITY
"fopographicdLand setting
❑Ridge ❑Slope ®Valley 0
(check appropriate box) ''
Latitude/longitude of welllocation.. -':',
3505.200W8355.918W .,',-..
(dcgrees/minutes/scconds) l c, -,
Latitude/longitude source:K1GPS❑Topog hie
(check box)
DEPTII DRILLIN
From To Formation De
0' TO 40' RED CLAY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Et. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Pt.
Prom_ To Ft.
40'TO60' SAND
60' TO 100' BROWN DIRT
100' TO 140' GRANITE
140'TO545' GRANITE
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.
\f '� o
,‘LP
tn,.
C�a`5
Yo
chy-
4-Q
16. REMARKS:
I DO (HEREBY CERTIFY TI(AT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A C'pPY OF TIIIIIS RECO) HAS BEF.N PROVIDED TO THE WELL OWNER
1.cecz /2- '0 3
SIGNATN(�EOFP SON CONS' dCTINGTHEWELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
'

283507
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
x 5
329
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELT. CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PIIONE x f 828) CERTIFICATION II 329 8
STATE WELL CONSTRUCTION PERMIT*/ ASSOCIATED WQ PERMIT/1
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El Municipal Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
BARNETT RD TO PINEY WOODS WAY
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ALLAN FLADD
Address 3322 SOUTHWEST 5TH AVE.
(Street or Route No.)
CAPE CORAL, FL 33914
City or Town State 7ip Code
( 239 )- 945-4694
Area axle- Phone number
4. DATE DRILLED 12-16-2003
5. TOTAL DEPTH: 225'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 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 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST AIR
10. WATER ZONES (depth): 180'
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 102
From To FL
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
Material
Ft. CEMENT
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 1/8" SDR 21 PVC
Method
GRAVITY
Slot Size Material
in.
in.
Size Material
Ft.
Ft.
Topographic/Land setting
®Ridge °Slope ❑Valley ❑Flat
(check nppmpriate box)
Latitude/longitude of well location
3508.004N/8358.616W
(degreen/minutes/seconds)
Latitude longitude source:EaGPS°Topographle-gtap
(ekDRILLING1LOG
Formation Deshriptioa--
RED CLAY
80' TO 102' SANDSTONE
BLUE SLATE
GRANITE
DEPTH
From To
0' TO 80'
102' TO 225'
0 '-
LOCATION SKETCH o n73
Show direction and distance in miles from1leas _,71
two Stale Roads or County Roads. Include4 roa4= '
numbers and common road names. v
T
W
cJt
W
rrl
�/1t2NL t RD
11)0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WTI II I5A NCAC 2C, WELL
CONSTRIJCT'ION STANDARDS, AND THAT A CpPY OF TIES RECORD AS BEEN PROVIDED TO THE WELL OWNER
/2 /G-03
SIGNATURE OF
TING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Senlee Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
i

283506
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION N 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. priONE N [phone]
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WO PERMITS!
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El MunicipaVPublic O industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
2459 CANEY CREEK RD
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: MARKSTALCUP
Address P.O. BOX 1098
(Street or Route No.)
MURPHY, NC
28906
City or Town State Zip Code
( 828 )- 837-2219
Area axle- Phone number
4. DATE DRILLED 12-08-2003
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 5 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of using terminated aUnr below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 10 METHOD OF TEST AIR
10. WATER ZONES (depth): 340'
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 260 Ft. 8 1/4*
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK
Amormt 100 PPM
Wall Thickness
or Weight/Ft. Material
.188 STEEL
Method
GRAVITY
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Depth Size Material
From To R.
From To Ft.
16. REMARKS:
Topographic/Land setting
[Midge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitudc/longitude of well location
3502.487N/8402.834W
(degec s/minutes/seamds)
Latitude/longitude source:KIGPSOTopographic map
(check box)
DEPTH DRILLINftWQ
Formation Description
From To
0' TO 100'
RED CLAY
100' TO 140' SAND
140' TO 200' RED CLAY
200' TO 260' BLUE SLATE
260' TO 505' BLUE SLATE
LOCATION SKETCH
Show direction and distance in miles froniatlrnat
two State Roads or County Roads. Include the road
numbers and common road names.
I DO I IEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED EN ACCORDANCE writ 15A NC AC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A CO; Y OF T[US RECORDS BEEN PROVIDED TO THE WELL OWNER
/?.—S-03
SIGNAIU• OF PE
LNG THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Servlce Center - Raleigh, NC
27699-1636I'hone No. [phone], within 30 days. GW-1 REV. 07/2001

City or Town Stale
( 770 )_ 928-4814
Arca code- Phone number
4. DATE DRILLED 12-12-2003
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO KI
7. STATIC WATER LEVEL Below Top of Casing: 10 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated al/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST AIR
10. WATER ZONES (depth): 180'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION N 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE N [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
12755 JOE BROWN HWY
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: MIKELAVASSER
Address 1021 WILEY BRIDGE RD
(Street or Route No.)
WOODSTOCK, GA 30188
Zip Code
11. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING:
From To
From To
13. GROUT: Depth
From. 0 To 20
Depth
From 0 To 110 F
F
Ft.
t.
Material
Et. CEMENT
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
Wall Thickness
Diameter or Weight/Ft. Material
t. 61/4" .188 STEEL
Method
GRAVITY
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
283505
Topographic/Land setting
❑Ridge ®Slope [Walley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3510.463N/8407.731W
(degrees/minutes/seconds)
Latitude/longitude source:IDGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Desc pdiptirr:—---
0'TO40' RED CLAY
40'TO80' GRANITE '" r
80' TO 110' GRANITE '.,.'
110' TO 505' GRANITE
i
BLUE SLATE !
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the toaff
numbers and common road names.
CA)
O
Fri
16. REMARKS:
0
0 —
11)O IIEREBY CERTIFY TEIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT/ COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
DATE
SIGNlf'VURE OF
CLING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prim) LARRY F. JONES CERTIFICATION # 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PRONE # 1828) 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential R1 MunicipaUPublic 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
CULBERSON RD - BRUCE MTN. LOT 14
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: DWIGHT & CAROLE HALL
Address 1179 MILMUR DRIVE, NORTHWEST
(Street or Route No )
ATLANTA, GA 30327
City or Town State Zip Code
( 404 )- 351-4225
Area code- Phone number
4. DATE DRILLED 12-15-2003
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO gl
7. STATIC WATER LEVEL Below Top of Casing: 120 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 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST AIR
10. WATER ZONES (depth): 325'
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 70 Ft.
From To Et.
Front To Ft.
GROUT: Depth
From 0 To 20
From To
SCREEN: Depth Diameter Slot Size
From To Et. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Siu
From To Ft.
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
6 1/8' SDR 21 PVC
Material
CEMENT
Ft.
Et.
Material
From To Ft.
16. REMARKS:
283504
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3459.435N/8407 682W
(degrecdminutcs/seconds)
Latitude/longitude source:KIGPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Desertptlarr—E__'
0' TO 20' SANDSTONE
20' TO 40' RED CLAY n J i
40'TO 70' GRANITE -., 1 r-
70' TO 505' GRANITE
LOCATION SKETCH
Show direction and distance in miles from t
two State Roads or County Roads. Include ro
numbers and comnx road names.
t DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W till I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TH T A COPY OF THIS CORI) IIAS BEEN PROVIDED TO THE WELL OWNER
SIG ATUR
TRUCTUNGTIH> WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
283503
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W'EI,I, CONTRACTOR (INIMVIDUAL) NAME (pdn0
CALVIN W. ROSE CERTIFICATION 8 3327
WELL CONTRACTOR COMPANY NAME
ROSE'S WELL DRILLING PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITti
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential KI Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
WEHUTTY RD
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: AUNDIS HARRIS
Address 4402 NORTH SHORE LN
(Street or Route No.)
NORCROSS, GA 30093
City or Town State Zip Code
( 770 )- 923-3057
Area code- Phone number
4. DATE DRILLED 12-02-2003
5. TOTAL DEPTH: 400'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO gl
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
"Top of using terminated allor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 2 METHOD OF TEST AIR
10. WATER ZONES (depth): 140'-1 GPM
375' - 1 GPM
11. DISINFECTION: Type CHLORINE
Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 70 Ft. 6 1/8" SDR 21 PVC
From To Ft.
From_ To Ft.
13. GROUT: Depth
Prom 0 To 20 Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Front To Ft.
From To Ft.
Material
CEMENT
Method
GRAVITY
I'opographic/Land setting
®Ridge ❑Slope ❑Valley OFlat
(check appropriate box)
Latitude/longitude of well location
35D 5.14W/84D 15.90W
(degrees/minutes/seconds)
Latitude/longitude source:KIGPS❑Topographic map
(check box)
DRILLING LOG
Formation Derseriptier---- —:
SET CASING
SLATE
16. REMARKS:
DEPTH
From To
0' TO 70'
70' TO 400'
LOCATION SKETCH
Show direction and distance in miles fromlat least
two State Roads or County Roads. Includd4he-teed-----c--"--
numbers and common road names.
C. )
I DO IIEREI3Y CERTIFY THAT THIS WELL WAS CONSTRUCT"ED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND RAT A COPY OF THISRECORDHAS BEEN PROVIDED TO THE WELL OWNER
d(di.�. %'e /eel _ /2 -o 2 'OS
SIGNATURE OF PERSON CONS "I'RUCFING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Mall Servlee Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION 0 3295
WELL. CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMAPANY, INC.
STATE. WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# (if applicable)
(if applicable)
284242
PHONE # (828) 83r.s008— -rCIT
__
I. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
TARHEEL WEST
(Street Name, Numbers. Cmnmunity, Subdivision, Lot No., Zip Code)
3. OWNER: ARVIL COOK
Address 865 PENLAND RD
(Street or Route No.)
BRASSTOWN, NC
City or Town State
( 828 )_ 837-7566
Area code- Phone number
4. DATE DRILLED 12-29-2003
County CHEROKEE
28902
Zip Code
5. TOTAL DEPTH: 265'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 80 ET.
(Use "✓' if Above Top of Casing)
S. 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 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST AIR
10. WATER ZONES (depth): 220'
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 97 FL 6 1/8"
From To Ft.
From To Ft.
13. GROUT: Depth
Material
From 0 To 20 Ft. CEMENT
Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
16. REMARKS:
Method
GRAVITY
Topographic/Land setting
UlRitlge ❑Slope ❑Valley ❑Flab
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:0GPSOTopogmph4cmap_.__
(check hex)
_DEPTH DRILLING LOG
From To Formation Description
0' TO BO' RED CLAY
80' TO 97' GRANITE
97' TO 265' GRANITE
Slot Size Material
in.
in.
Material
L)
s �m
Z cm
oC
J -cr';
no
Ina ell
LOCATION SKETCH SS o
Show direction and distance in miles from atJe ist rni
two State Roads or County Roads. Include tI oad�^;
numbers and common road names. C) '-'
IV Ei
z
tL
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAL19 COPY OF T115RECOR IAS BF.EN PROVIDED TO THE WELL OWNER
SIGII4CTURE O�j)ERSO
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
DATE

WELL CONSTRUCTION RECORD 2 8 4 3 2 6
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
R ) I CERTIFICATIONS )4/0V
WELL CONTRACTOR (INDIVIDUAL) NAM(print) �i CAM PA �1"i `5 tr)'ii �Ti_.i47
�`/��I�krof PHONE 'S (`A:iaa.-------
W WELL CONTRACTOR COMPANY NAME --_
ASSOCIATED WQ PERMITS r---
(if applicable)
STATE WELL CONSTRUCTION PERMITS
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
DRidge (jape ❑Valley ❑F{a(
(check appropriate box)
Latitude/Iongitut de Decll location
/v3��g1v1w Ife32
I 1I (degrees/minutes/seconds)
3. Address
: -0c6 \ lit _CA Latitud .'b Eitude source:❑GI'S❑Topoc-ruaP'-
Address %-� 't�.2V Cf Route No.) rrh:ck box)
(Streetolr 0.�ip CPE?TH (jLL l 0Q.
1D}0.m0. JFrom To Fro atior Dacriptio
City or Town State Zip Code O — S o t e cx ck1
2. WELL LOCATION: Countyi f f nf� E
Rr pf ' tANn\iotA
(Street Name, i:uni c^ Community, Subdivision, Lot No., Zip Code)
Area code- Phone number
4. DATE DRILLED.I�{
5. TOTAL DEPTH: a^S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑
7. STATIC WATER LEVEL Below Top of Casing: i GC t FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S FT. Above Land Surface"
'Top of casing terminated at/or below land surface requires a
variance In accordance with ISA
MCAC 2C .0118.
D OF TEST F4 t �L
9. YIELD (gpm): —
10. WATER ZONES (depth):
11. DISINFECTION: Type - Amount l5)1
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
p To —Ft. (o,:� " SOL2J
From
From To
From_ To
13. GROUT: Depth
From r) To at
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To__
Ft.
Ft.
Material
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Ft.
Ft.
Size Material
Method
c
O
— o
f -Jam•_._
r nnAT10N SKETCH °"
Show direction and distance in miles file at Fist
two State Roads or County Roads. Include tMetoad
numbers an cornmoroad names.
16. REMARKS:
I DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�� iL� /&- /r-OS
. DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the eriglnal to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center, �Vgh, NC
27699-1636 F iioue Nc. rn,m 733 1771. ♦ ' 3 w ys.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater
roCERTIFICATION
Section
WELL CONTRACTOR (INDIVIDUAL) NAME ;print)1�'1F� �\' >\\� \ PHONE t t3� S(n
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT*/
if applicable
2. WELL LOCATION:
Nearest Town: COL"'
/i!/ well
ASSOCIATED WQ PERMIT*/
if applicable
284338
1. WELL USE (Check Applicable Box): Residential fJ Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
Topogra ic/Land setting
❑Ridge tallSIlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(Street Name, Numbers, Community, Subdivision, Lot Na., Zip Code) .•/ . (^J 1p r.r r I
(� ck C1�n ^ — (degrees/minutes/seconds)
3. OWNER. {� i nN f�(�(V Latitude/longitude sourcc:UUPS❑Topographic map
u n 0 t i 11 �� (check box)
Address (Str�co,CRoute No.) i-.%QDy_Q Y1oTH j�gILL!Ng1 PG
FrRm To Fnrmatiou Description
Zip Code ( %kt
City or Town State
Area code- Phone number
4. DATE DRILLED Deg
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO
7. STATIC WATER LEVEL Below Top of Casio
c0 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 L2 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): N METHOD OF TEST Ar
10. WATER ZONES (depth): CO
County °Jer Ken
e. %/t_' 5
1. UIJINCE%TarION. Typef
2. CASING:
Depth Diameter
d FronCO____ To C/O Ft.
From To Ft.
From To
13. GROUT: Depth
FronnTo w
�
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount _It__
Wail Thickness
or Weight/Ft- Material
sD
Ft. ---
Material
FL 'Dir G
Ft.
Diameter
FL in.
Ft. in.
Method
Slot Size Material
in.
in.
Material
1 OCATION SKEI Clt
Show direction and distance in miles from at least
two 3iaic Roads or County Roads. Include thZroad
numbers and common road names. F. o
L CDni
m
n
ern
3 �o
en=
O m7o
y
O
z
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TOTHE
WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenteri R IVgh, C
27699-1636 Phone No. [phone], within 30 days.

284493
WELL CONSTRUCTION RECORD
North Carolina - Department of Fnvironment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prino LARRY F. JONES CERTIFICATION" 3295
WELL CONTRACTOR COalPANY NAME CHEROKEE WELL DRILLING AND PUMP COMAPANY, INC. P11oNE # 1828) 837-8686
STATE WELL CONSTRUCTION PERMITH _ ASSOCIATED WQ PERMIT"
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential al Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
SIERRA CIRCLE T/:14C.I CO 1.Q T S
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Cede)
3. OWNER: GLENN ROBERTS
Address 6165 WEST U.S. HWY 64
(Street or Route No.)
MURPHY NC 28906
City or Town State Zip Code
( 8285 837-8557
Area code- Phone number
4. DATE DRILLED 12-31-2003
5. TOTAL DEPTH: M7'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "r" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of easing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST AIR
10. WATER ZONES (depth):
Topographic/Land setting
KtRidge ❑Slope ❑Valley ❑Flat-
(check appropriate box)
Latitude/longitude of well location.
(degrees/minutes/set-sands)
Latitude/longitude source:OGPSOTopographic_map
(check box)
DEPTH_ DRILLING LOG
From To Formation Descrj Lion c'
0' TO 60' RED CLAY )-- o
60' TO 81' GRANITE (_ ��
b =m
81'TO 847' GRANITE c�
ny. Zm
rTn
0
m C-'
(1 N2
,.ta
tV .nt
11. DISINFECTION: Type CHLORINE
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 81 Ft. 6 1/8" SDR 21 PVC
From To Ft.
Amount 100 PPM
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT ACC' OF THIS RFC a'a 11 ( PEN PROVIDED TO TILE WELL OWNER
SIGNATU
N CON RU ��GTHE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenter' RRaalvg? NC
Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
Nor;h C_ _ ..,-Do-_. for - iron ent a. d Natural Resources Division of WaterQu_
1tiELLCOYTRAC1'0°(I)DIY'(DL(print)
Ja:-!e5 E. Erc'Ct
YSEI.L COYT R+1CT OR COIN PA. NY NAA:EHeaaan Brothers Well Drilling, Inc
S t{TE WELL CONSTRICTION PER31ITP ASSOCIATED WQ PERN11Tt
(if ac-:iic=blel
azolicable)
293850
Oro.. d,ate-Section
CERTic ATIO'V: 205
PHONE 629') 369_9S91
I. WELL USE (Check k.Apli:ac'e Ez<j: Resiaential Muni '.ip_Ur 'olio ❑ indUstrial 0 Agriculttmal
Mloaitoring ❑ •Recovery G Heat Pump VVater Injection ❑ Other 0 If Other, List Use
2 WELL L LOCATION
Nea t o Nn /'/I I I h I1. Coin;v
(9 ' N, we., Nunn Cc i.. nity, Su:di :ro La N_ , Zip Ccde)
3. 0'v1/4N E' S L6 OAS,g P i
Ad CS5 /0-a U..
`I tIAAtti NCB c95
Big "y ! go 5 e
Are, eie Phc,:e ncr7:per
5. TTDRILLED 03
5. TOTAL DEP:6. DOES WELL RE?LACE EXISTING WELL? YES ❑ NO
". STATIC WATER LEVEL Eelow'Top of Casing:
5. TOP OF CASING IS 2 FT. Above Land Su„_
'Top of casing tcrminate: at'or below land surface requires a
variance In ar_crdan with l5.A NCAC 7C .0119.
S.'YIELD (gpr..): METHOD OF TEST blow
10. WATER ZONES (depth):
Leo
Toccz:apnic'Land setting
ORidge r'S OLaI OF1at
e,
Latitudellonitittrda ollweli location
,L.Ico LitH e, s_ ce GOPS o ara oup
(check cox)
DEPT-, DRILLING LOG ''
From.To Fop-n tic bes r t'on--
O clay &, sand
I I, DISINFECTION: Tvoe H T H Amount . ) E CZ
12. CASING: Wall Thickhess
Depth Diame1e cr Weight/Ft. T' erla.
From 0 TTo Ft.
Ft
From To Ft,
13, G.ROUT: Depth Mate ia'I t iethoc.
Fri n 0 To 20 Ft, i-udte & tL......L AWcr'ui
From To • Ft.
14. SCREEN: Depth D:a:reter Sic'. Size Tda:erial
From To F: in. in.
From I To Ft. in. in.
15. SAND;GRAVEL PACK:
Depth • Size Material From To Ft.
From To Ft.
cra--tite
LOCATION SKETCH
Sho.. direction and distance in m„-s from. a: least
t'.vo Slatc Roads or Co Rr-ads. Include tne road
numbers and common ' narces.
o `'
16, REMARKS'
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I SA NCAC 2C, WELL
CONSTRUCTION: STANDA.RDS,ND THAT A COPY OF THIS vAS BEEN PROVIDED t0 THE WELL OWNER
UN.ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1E36 iVsl1 Service Cent;r - Raleigh, NC
:7699-1636 Blinn: No, (919) 733-322I, within 30 days. GW-1 R.E V. 07 2001

WELL CONTRACTOR (INDIVIDUAL) NAME (print LARRY F. JONES
WELL CONSTRUCTION RECORD
NOT Carolina - Department of Environment and Natural Resources - Division of Willer Quality - Groundwater Section
CERTIFICATION X 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP CO., INC. PHONE # [phone]
wk
I. WELL USE (Check Applicable Box): Residential DB Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Usc
STATE WELL CONSTRICTION PERMIT#
(if applicable)
278272
ASSOCIATED WQ PERMIT('
Of applicable)
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
TANGLEWOOD FOREST
!Street Name, Numbers, Community, Subdivision, Lot No., Zip Cede)
3. OWN ER: DR. STEPHEN ZIMMER /JUDY GALLAGHER
Address 1878 TANGLEWOOD RD
(Street or Route No.)
MURPHY, NC
28906
('itv or Town State hp (:ode
( 828 ). 837-9367
Area c !e- Phone number
4. DATE DRILLED 07-24-2003
5. 'TOTAI, DEPTH: 100T
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NC) El
7. STATIC WATER LEVEL Below Top of Casing: 524 FT.
(Usc "4" if Above Top of Casing)
R. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated al/nr below land surface requires a
variance In accordance with 15A NCAC 2C .11118.
9. YIFLD(ppm): 1000PD METHOD OF TEST AIR
I0. WATER ZONES (depth):
-I'opographic/Land setting
Midge ID Slope ❑Valley ❑Plat
(check appropriate box)
Latitude/longitude of well location
i dc(urrsimimnes/sccnnds )
Latitude/longitude source:❑GPS❑Topographic map
(check ixrx)
DEPTH DRILLING LOG
From To Formation Description
0'TO33' RED CLAY
33' TO 1007' GRANITE
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 33 Ft. 61/8"
From To Ft.
From To Ft.
13. GROAT: Depth Material
From 0 To 20 Pt. CEMENT
Amount 100 PPM
Wall Thickness
or Weight/Et. Material
SDR 21 PVC
From To Ft.
Method
GRAVITY
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To _..__ Ft. in. in.
15. SAND./GRAVEL PACK:
Depth Size Material
From 'To Ft.
From
To
Ft.
16. REMARKS:
L(XATIONiTCH
Show direction and distance in miles from at !cast
two State Roads or County Roads. Include the road
numbers and common road names.
1 130 IIEREUY CERTIFY THAT TIIIS WELL WAS CONSTRIK:1 E.l) IN ACCORDANCE WIT!! I5A NCAC 2C, WELL
('ONSIRIK"IION STANDARDS, AND111,4f A COPY OF THIS}ifj'ORD IIAS BEEN PROVIDED 10 T11F. WELL OWNER
1'-3 -o3
SiGNATU1f %oF PEICSOAY'jy0NS1RUCI1NG 'HIEWELL
Submit the original to the Division of Water Quality, Ctrol d tiTil tat Sekiiort, Ifi4 1K Ma1i SFt�'id
11,
27(199-16.16 Phone No. [phone], within 30 days.
DATE
er - Raleigh, NC
-I REV. 07/2001

WELL CONS',RUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pan) LARRY F. JONES CERTIFICATION N 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE N j828) 837-8008
STATE WELL, CONSTRUCTION PERMITN ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Monicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ANDREWS County CHEROKEE
SHERWOOD ESTATES
(Sttret Name, Number, Community, Subdivision, Lot No., lap Code)
3. OWNER: LLOYD KEITH
Address 320 BAY VISTA AVENUE
( Street or Route No.)
OSPREY FL 34229
City in Town State Zip Code
( 941 T. 966-6844 .
Arra code- Phone number
4. DATE DRILLED 08-11-2003
5. 'TOTAL DEPTH: 907'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 75 FT.
(Use "r" 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
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): PINT METHOD OF TEST AIR
10. WATER ZONES (depth):
278275
Topographic/Land setting
[Midge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(rl egrees/minutecrsecnnds )
Latiluddlongitude sourcc:OGPSOTopographic map
(check Ixrx)
DEPTH DRILLING LOG
From To Formation Description
0' TO 80' RED SANDY CLAY
80' TO 907' SLATE
GRANITE
I I. DISINFECTION: Type CHLORINE
12. CASING:
Depth
Frain 0 To 80 Ft
From To Ft
From-� To Ft.
13. GROUT: Depth Material
From 0 To 20. Et. CEMENT
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
6 1/8" SDR 21 PVC
From To Ft.
Method
GRAVITY
14. SCREEN: Depth Diameter Slot Size Material
From To Pt. in. in.From To---- Ft. in. in. —_--
15. SAND/GRAVEL PACK:
Depth Size Material
From To Pt.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and corona road names.
�/ yj�LLe
c_1
O
�Jt �b
F G
1 INS IIERFBY CERTIFY 1HAT THIS WELL WAS CONSTRUCT ED IN ACCORDANCE WIT II ISA NCAC 2C, WELL
CONS RUCTION STANDARDS, AND TI T A COPY OF TIIIS RPRD HAS BEEN PROVIDEU'TO THE WELL OWNER
GNAT lyl.E OF PER
'FRUCIING THE WELL DATE
Submit the original to the Division of Water Quality, GroundwaiteF$)ction, 1636Iinl) Serlice en
27699-1636 Phone No. [phone], within 30 days.i.�,,f}';‘,
J Ll
t
r it n tV)A,r7 SECTION
4l \fil L fii .ICI nrrarr
lelgh, NC
,V.07/2001

278274
WELL CONSTRUCTION RECORD
Noel) Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION it 3295
WEI.I. CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE a [phone]
STATE WE.I,I. CONSTRUCTION PERMIT# ASSOCIATED WO PERMITS/
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MARBLE
HWY 141 TO ZEKE LN
(Street Name, Numbers, ('ammmmity, Subdivision, Lot No., Zip Code)
County CHEROKEE
3. OWNER: WINDELL ANDERSON
Address 1425 BURNT SCHOOL HOUSE RD
(Street or Route No.)
HAYESVILLE NC 28904
City or Town Stale hip Cate
(_828 )-389-8986
Art -a cede- Phone number
4. DATE DRILLED 08-07-2003
5. TOTAL DEPTH: 145.
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 15 FT.
(Use"✓' if Above Top of Casing)
K. "1.01' OF CASING 1S 1 FT. Above Land Surface"
`Top of casing lermbrnted stlor below land surface requires a
)grinner In accordance vtIth ISA NCAC 2(7 .0118.
9. YIELD (gpm): 20 METHOD OF TEST AIR
O. 11'AT? R ZONES (depth): 60'
I I. DfSINI ECTION: Type CHLORINE
Amount 100 RPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Et. Material
from 0 To 35 Ft. 61/8" SDR 21 PVC
From '1'o El.
Flom ----To FL
13. (KOLA: Depth Material Mel hod
Horn 0 To 20 FL CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From TtyFt. in. in.
From To Ft. in. in.
15. SAND/GRAVFL PACK.
Depth Size Material
I lomTo Et.
Pram____ __T o__ Et.
Topographic/Lend setting
❑Ridge ®Slope Malley 0Flat
(check appropriate box)
Latitude/longitude of well location
plcgrees/mimncs/seumds )
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTII DRILLING LO(i
From To Formation Description
0' TO 10' RED CLAY
10' TO 20' GRAVEL 8 SAND
20' TO 35' GRANITE
35' TO 145' GRANITE
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
16. REMARKS: _o_
�' o
I Ix) IIFREI3Y CEICIIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTR(ICTTON STANDARDS, AND THAT ,(Q COPY OF 1(Ij5 RIECO[ HAS HEEN PROVIDED TO THE WELL OWNER
3-7-c,3
SIGIC"ATURE
PERSdN CON
Submit the original to the Division of Water Quality, Grot
27699-1636 Phone No. [phone], within 30 days.
CTING THE WELL DATE
er - Raleigh, NC
-1 REV. 07/2001

WELL CONSTRUCTION RECORD
Not di Carolina - Dclial inert of Environment and Natural Resources -
t\ F:LI. (OSl ll:AC'I'OR (INDIVIDUAL) NAME (e.t
(wrintt)'1 7GC 'C1 v )
t\ I I.I. ('tIS'I It:\CI O121 O\II'ANY NAM:: a'K'�l W`/' It
2'78213
Division of Water Quality - Groundwater Section
t``.5 _... _..___— _..__ _ CERTIFICATIONM aS 7d-
Co -A' Nc, PHONE tl 136 1/6Y-(/(1<%O
SI ,\ 11. \VI.1 1. ('o,NSlIt1IClION I'ElRMrl'q ASSOCIATED \PQ rrRPII'td
(if apnlicabIc) (if applicable)
I. \\ELI. I ISE (Check Applicable Box): Residential Municipal/Public ❑
D,lnnibrring ❑ Recovery ❑ Ilcat Purnp Water Injection ❑ Other ❑
VVI7 1. LI:)CA I7 ON:
N carest down: /11Aa_ �"E ���� Count)
t2.' V,ye ")Iq +t? [`Q. C� s j
Curer: `.`anu:. uorbcr,s. Community'. Subdivision. Lot No.. Zip Code)
:)ANNUL. L/JR : 3° 0�2.
\ddrrxs U I<f V jf_Iot?.i N3.,c
tiveel or Route. No)
t ltv or lino Stye - Zip Code
170 I. k�5 - ✓qsl
Area col:. Pitons number
4 DATE OKI(.I.LD l Itib3
3t}/oi
leyeLee
5. l Ol AL DEPTH: BC.
6. DONS VVNLI. REPLACE EXISTING WELL? YES ❑ NO ❑
7. SIA'Il('WATNItl_P.VELBelow Top ofCasing: 7,S0 FT.
77 IUse "+" if Above Top of Casing)
S lY)I' OF CASING IS 1 FT. Above Land Surface*
'top u( casing terminated at/or below land surface requires a
varia uve in accordance with I5A NCAC 2C.0118.
9. YIELD (ppm):-'—MEnIODOF
1(I. WATER ZONES (depth):
II. I)ISINI:ECI ION fypc_0INS Amount _1pU LvL�,Ay_
12. CASING: Wall l-hickncss 7�/
Depth -Diameter or Weight/ft. Material
I'loln_"!"'l.___ do_..&5 FL (0.1)-y 0(2-)I .yPIJC.
I roan _-- I o __-_— Ft.
From To Ft.
13. LiROU I : Depth Malcrial / Method
Prom__O__.. I•o_1?uEt. 50-J4ef'mv4�" /1,,ApsW'tl
u I.ttn To FL
I1 tit Itl.E. N.--- 1)con) Diameter Slot Sizc Material
non To
To
s `:.ANl)NRAVE.I. PAC
Ikhl l:
I Eon In
How lu
1(1. I.: EMUS:
Et. in
PI. n
Sin!
II.
Pt.
N1:itcr i:11
Industrial 0
II Other, List Usc
Agricultural ❑
4(4 1W
Topographic/Land tting
Clltidgc ❑Slope fWeralley ❑Flat
check appurptialc box)
I. al i ludcl longitude of well location
(tle grecs/I ninule stsccunds)
I. ntitudc'longiludc source:❑GPS❑Topoerapllic nap
(check boil
U I:I'l ll DRILLING LOG
Porn To , For :Mot Description
bri-
5o
Ive 6fUest '
3oo9 -)Y 6•0>10—
LOCA"I ION SKETCH
Show (Mention and distance in miles from at (cast
two State Roads or County Roads. Include the road
number s and common road names.
1 DO 11E1211IY C'I:RI I1 Y 111ACf TI IIS WELL WAS CONSTRUCTED IN ACCORDANCE AVITI-i ISA NCAC 2C, WELL,
('I N'-: I RU(' III )N STANDARDS, AND TI IAT A COPY OF THIS RECORD HAS I3EFN PROVIDED TO TI IE WELL OWNER
4)l)O3
OF PERSON CONSTRUCTING TI IE WELL. )ATE
Suhmil thy original to the Division of Water Quality, Gro indwater Section, 16.16 Nlail5er}sp c fj4nter - Raleigh, NC
2ace:-I636 Phour No. 0119) 733-3221, within 30 (lays.
\V- I IL EV. 07/2001
I=.R(1111oip;
R SPCTInM

2. WELL LOCATION:
Nearest Town: ANDREWS
SHERWOOD ESTATES
I Street Name, Numbers, Community, Subdivision. lot No., Zip Code)
WELL CONSTRUCTION RECORD
Not Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater
rCERTIFICATIONuwto e Mtion
3295
WELL CONTRACTOR (INDIVIDUAL) NAME (prtn0 LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. ppONF, 8 (8281 837-8008
ASSOCIATED WQ PERMITB
STATE WELL CONSTRUCTION PERM1IITM (if applicable)
(ifapplicablcl
1. W'FI 1 USE (('heck Applicable Box):Residential till Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring O Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
'topographic/Land setting
❑Ridge ®Slope ❑Valley DElat
(check appropriate box)
Latitude/longitude of well location
County CHEROKEE
3. OWNER LLOYD KEITH
Address 320 BAY VISTA AVENUE
(Street or Route No.)
OSPREY, FL 34229
City or Town State
( 941 )-_966-6844
Area cede- Phone number
4. DATE DRILLED 08-11-2003
5. TOTAL DEPTH: 907_
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top ofCasing: 75 FT.
(Use "✓' if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated al/or below land surface requires •
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): PINT METHOD OF TEST AIR
III. WATER ZONES (depth):
lip Code
I I. DISINFECTION. Type CHLORINE Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 61/8" SDR 21 PVC
from To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. _ in.
15. SAND/GRAVEL PACK:
Depth Sim Material
Method
GRAVITY
From ToEt.
From ------I o-- Et.
(degrees/minutes/seconds)
Latitude/longitude souree:f]GPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 80' __ _ RED SANDY CLAY
80' TO 907' SLATE -_
GRANITE
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and commgn road names.
tAR
16. REMARKS: --------- ----
1 IX, IIERERY CERTIFY 1 HAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wllil ISA NCAC 2C, WELL
CONS !RUCTION STANDARDS. AND TI T A COPY OF THIS RERC!]121) IIAS BEEN PROVIDE:D'IO 111E WELL OWNER
Cr—
TRUCIING THE WELL DALE
Submit the original to the Division of Water Quality, Gran
27699-1636 Phone No. [phone], within 30 days.
il1/2vjeriSectlon, 1636 Mali Serslc I
L L
- Raleigh, NC
1 REV. 07/2001
278275
r
0
ASHEVLLL FiL'al
SECTION
!rl_ iFFICE

278274
WELL CONSTRUCTION RECORD
Notch Carolina - Department of Environment and Natural Resources - Division of Watcr Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION # 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE a [phone]
SFA'lE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) OF applicable)
1
WELL USE (Check Applicable Box): Residential E0 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Usc
2. WELL LOCATION:
Nearest Town: MARBLE County CHEROKEE
HWY 141 TO ZEKE LN
(Street Nmnc, Numbers, Community, Subdivision, Lot No . 7Jp Code)
3. OWNER: WINDELL ANDERSON
Address 1425 BURNT SCHOOL HOUSE RD
(Street or Rnute No.)
HAYESVILLE, NC 28904
City or Town Stine Zip Code
( 828 )_ 389-8986
Area er tie- Phone number
4. DATE DRILLED 08-07-2003
5. TOTAL DEPTH: 145'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC' WATER LEVEL Below Top of Casing: 15 ET
(Use "(-" if Above Top of Casing)
R. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated attor below land surface requires
variance In accordance wllh 15A NCAC 2C .01I11.
9. YIELD (gptn): 20 METHOD OF TEST AIR
o. WATER ZONES (depth): 60'
11. DISINFECTION: Type CHLORINE
Amount 100 PPM
12. C'ASIN(i: Wall Thickness
Depth Diameter or Weight/FI. Material
Hein 0 To 30 FL 61/8" SDR 21 PVC
From_____ 'To It.
Rom__ To_ Ft.
IS. GROUT: Depth Material Mclhnd
From 0 To 20 Ft. CEMENT GRAVITY
Flom To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Prom To _.._. Ft. in. in.
From
To Ft. in. in.
15. SAND:GRAVEI. PA'. 'K:
Depth Size Material
It��nt to Ft.
from To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appmpriatc box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude sourcc:OGPSOTopographic map
(check box)
DEPTH DRILLING L(X3
From To Formation Description
0' TO 10' RED CLAY
10' TO 20' GRAVEL & SAND
20' TO 35' GRANITE
35' TO 145' GRANITE
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
1 DO IIERF.I3Y CERTIFY THAI'TIES WELL WAS CONSTRUC[ED IN ACCORDANCE WIT7I 15A NCAC: 2C, WELL
(ONSIRUC iON STANDARDS, AND TIIATT COPY OF 11118 RECOHAS BEEN PROVIDED TO THE, WELL OWNER
5-7-o3
SIG
ATTIRE
Submit the original to the Division of Water Quality, Grotto
27699-1636 Phone No. [phone], within 30 days.
L
CLING THE WELL DATE
§#dick, 1&36 'li' all'.*'erVlee
- Raleigh, NC
1 REV. 07/2001

WELL CONSTRUCTION RECORD
Nul1h Carolina - Depalllncnl of Environment and Natural Resources - Division of Water Quality - Groundwater Section
V' 11 C1)N"I UM' FOR (INDIVIDUAL) NANI E (print) 0 )cC -. CY1 k1,0•Th CERTIFICATION a_2S'7�
sA b1.1 (-( IN 112AL-10IR ( ONIPANV NAME 0 ktc 1 (j)C It I -A, N(✓ PIIONE # j34 A'--(1Vklo
c IAll: w'I.I 1. CONS] lRRUC] ION PEItMIT# ASSOCIATED WQ I'ERl'1II ti
(if applicable) (if applicable)
2i8213
1. ACkl 1. 11SP. (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Min-MrMug ❑ Recovery ❑ Ileat Pump Water Injection ❑ Other ❑ II Other, List Use
:. AV'}I'1'IO/N,�..99tl�d p/�t1��
!Jew -es' .. [l(.J2E County
V�• yC' rqA G2 Ck'a�
(:aca ":;nnc. unlhcrs. Cnnmuullly, Subdivision, Lot No_ Zip Cod,!) Glunlhcrs. Cnnmmnlly, Subdivision. Lot No_ Zip
OAVJIIR: Ci''.) A:YN �1
\tldrp.;s UISV JJC.'v-74-,• oC%2_
()Meet or Route No)
G4
3uZoZ
itlet
sly or 1 men Sipe
1770 ). 1.15 -
5, TOTAI. DEl'TI1:
6. DOES AVELI. REPLACE EXISTING WELL? YES ❑ N ❑
7. : T All(' WATER LEVEL Below Top of Casing: 715.0 FT.
7 (Use '4' if Above Top of Casing)
.1 Or 1 )1-CASING IS 1 ET. Above Land Surface'
* 1 op of casing terminated at/or below land surface requires a
variance to accordance n'ilb 15A NCAC 2C.0118.
9. VILLD (Lprtl): METHOD I IOD OE TEST R.__.._._-
10. AA'ATIiIt 7ONES (depth):
Zip Code
Alen coda Phone nml.nr
a. DATL: DRII,LI!D Q I It ti)
Ste,
II- I)ISINI(ECIION. rypc_ ), kNf..,_ Amount _/)) /i)• 12. ('ASI NI is Wall thickness
1( Depth _ Diameter or AWeight/IT. Material
17nu1-'r.J._--- Fo _._d_5__ FI__l/0.1ay .$QFZ-) 1 r VG
I eon, To rt.
17ou, 'Ib H.
11 GROU I : Depth Mnlcrial // .Method
Qom v To _do Ft. So,I.14C-,,+ c'/" /1'Z4-po''f
Isom Tu It.
II tit RI EN: Dn11Ih Ihanlctcr Slot Sivc Material
I loin 'ro FL in, in.
Ilan Tr hi in.
18 8, ANI)'(iRAA Ill, I',V'K:
Dcl•IiI Size Mntetial
l ruin lr I1.
1 hilt .1 Pt.
I6. REMARK S:
/44k 7 ()
1TopographicThanctistRing
❑Ridge ❑Slope [W7alley ❑Llot
(check appropriate box)
1 aliiude longitude of well location
(degreeshninwes/seconds)
Lalit ids long nude 8l1u!cei❑GPS❑Topographic map
(check heel
DRILLING LOG
For (Mug Description
1)111'll1
From To ,
i /
/ %•
5-6�
cam. - 81.za
l
s-)'E' 6z>.34
3U09'-r)y 6.0_3ZY
COCA(ION SKETCH
Shots direction and distance in miles from al (east
two State Roads or County Roads. Include the road
numbers and common road names.
I IV) 11E121111Y C LICI111' T I IAT TI IIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
(i l,N lIitIN•1 )N SfANI)ARDS,AND TIIAr A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
1(j03
!S: I ATt F FERsoN C( Tl(^N'IIV.Rif: IN(i W EI I. hATF
J11
Submit the nri;;inal In the Division of Water Quality, (;r r in 1'Vater Section, 1G}rl Mail S
Jul
'"1(Th 1636 I'hnnr No. 0119) 733-3221, within 30 days.
enter- Raleigh, NC
OW-1 REV. I)7/2001
?'.CLIP.'( SECTION

278022
WELL CONSTRUC'FION RECORll
Noi Ul C,uolina - I )cpnllnlcnl of Environment and Natural2Itesoutucs - Division of Water Quality - Groundwater Section
III LI INN I PM.' Wit
.\It (INDIVIDUAL) NA NI (prlu II)__/ /12j/4/. j._ Sa) W4 _ CEIITIFICA'l1UNM 303/G
1I r I.; (IINI I \ 101t COMPANY NAME , LJtI4 tt'2. 7/ `n, �LIL'._ ..__..
S r.\ I I. IPi l.l. ( IL\S I HI'(I ION I'E.10111 H ASSOCIAT EII \PI) r•KI(:IIII #
l if applicable) (if applicable)
PHONE N jYigl 6 - -a
1 \VFI I. I ISI' (( heck Applicable 13ux): Rcsidenlial% Municipal/Public Cl Indusn3al ❑ Agricultural ❑
Rllmilorhip ❑ Itccmcr). El Heat Pump Water Injccliou ❑ Olbcr ❑ If 1)Ihcr, l.isl Ilse
— S07
.\V1'1.1. 1 (11'ATIOi : . Neal eel Town' /)j,.(A[llla County ln
'/Q2-LQ'
I 1 L_ T\) L cti 1 1)t'.J Cry
isocct Name. NmnboLl ati, nccul unonily. Subdivision, LolNo., Zip Code)
I (\V N;R:j4.)CI yi�C=k/
Add, es, 0/ l-5� S. t4l✓
nlRollie Nu.)
ar,
i/1U1{{j1�� , bLC `6JOCK
l-ilv nr ,ll•ou /51:'IS .N^ Zip Code
t 7b 1 - `� `, `I
teacndo I'hnnc nnndvt
d DAI t D3tI1.I.P1) g/20/D3
5. 1t)TALl)U'111 CQa '
6. DAIS \VEI.I. Rlil'I.A('I? EXISTING WELL? YES 0 NOS
7 SIAIIC\VAILItl, FVE_I.IScluwTopofCasing: 6L2 I
(Use"r" If Above lop of ('nsing)
8 1 O1' DE CASING IS __ 1 __ FI. Above Lead Sul lace
• iv ill raring ler ndnalv'l aVur brtary land rurhat requires
.:ni:oma It, nrrunlamre oral ISA NUAC )C .a11fl. �/7 _
I). YIIII.DIgpnl):..-2-MIs1110DOIrTrsT4/t (rc7mp L .SU'-_r,tlf J iZe a�+`'
10. WA IF1t /ONES (depth): -Z-2S ' - 4r Vrn Y 3 o22'f - 03 G.Oti
! _ _6rS es LOCATIONSICE:fCII
I I. : 1 ype � /7/ l/Armour -----_CCteJ Show dilecliun and distance in miles lion) al lend
12. Wall thickness two Slate hoods nr County (toads. Include the toad
or Weigle/II I\I:eelill mothers and rtnnnunl road umncs.
Topog,l�u IlierLanti selling
ClRidge 13Slope [Walley ❑Flat
(rhea :wimp; inic box)
I alitudr/longilud of Well lucaliun
>5UL{.'flS'&J�i�7, a‘sy�
Idcr,tecin nnlrc'strun(1s)
aliludr'lunl!ilutic coulrc'.❑<A'S❑Tnpogrl phic ulap
(check boa)
I?Ill'_I_I_I ORILL.INO LOCI
now Ta Formation Description
210'-
//Ic'- S71
_lila 14,! , sL± G'.Mi'Lc
/7,J Sn4/I /-rieG-„,/,
/t(,/ /714 ( G'ry 6-4,•"/c
S:,/f G- G
I)ISINFIlCI ION
1 'ASINI i'.
�1 Depth Di:ender
1 tom fo.._7,1._
From Tti PI.
St2/ di/C
13. (I Hit MI : urpth �,//Malletinl �/ Mcll „a
l tom U 1 n —2 .3 rl. ,Ve / /4y/ ! t.LLne_V ..-
1 l hill In FI
II. S('ItiI'N: Ikldh Dianlcicr Slot Sizc M;dcliel
Ilnnl_ _ fo �FI. �/ ill iu.
Ilom Tu PL , in. ill.
15. SANI)il RAVIil. PACK:
Droll Size
1 loin .% _all »' j, 11.
I tow/ ----_fu.,/_.__ Ft
I(1. IU MARKS:
Mnlcrlai
c:.
11 I II.REUV CI92I WY I IIA1' "1111S WELL %VAS CONSTRIR _ I ED IN ACCORDANCE WI 1 5A NCI\C 2C, %VET1.
GUNS( Iti IC I ION STANDARDS. AND 1IIAT COPY OP 1111S RECORD I IAS BEEN PROVIDED -I OIIIE. WELL OWNER
SIGNM OF PERSON ('ONE1 WELL{ 1
Li
Section, 161(I PL•dl Secs lc
Submit Ilse original to the Division of \Valer (Manly, Gfuuu I
27699 1616 flume No.I919) 713-1221, wltjild 30 (lays,
/lDd 6 J 1/
Cl.„)ALi, 11/4_I1 ✓r(/)' e,
20 l(9s
r • Raleigh, NC
-1 ItEV. 111/21101

s I\ 1 E w 1,1,1, CONS'I Itl'("I ION I'EItMITW
OF applicable)
I W E L I
i\loni! tring ❑
278021
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources • Division of Water Quality - Groundwater Section
wit 1. Cn♦T I(A(b it (INDIVIDUAL.) NAME (print) Jets, Wa{t ins CERTIFICATION a 2
w L LI. C'(1? IRAC1C 1111 oDI I'ANY NAME yADglro 1 (L. eco 1 c- PHONE a f3%1 )JG' _tyyo
Assocl: i n) wp PERnuT#
Of applicable)
USE (Cheek Applicable Box): Residential Pit Municipal/Public 0 Industrial 0 Agricultural 0
Recovery O Heat Pump Water Injection ❑ Other 0 II Other, List Use
2. \';01 LOCATION: I
Nearest Town: /}] tcogpk/ County Oteno
IStrcct N Numb is_ Community. Subdivision. Lot No., Zip Code)
3. OWNER: 1/14 6ar /1cileeR
Address
Y) /�1.y (Street or Route .)
�tc No
.)it
.or[/0-Oa52 r �Kr
City or'i own State Zip Code
(mac 1- • CC() 51
:Area code - Plume number
4. DA1T. DRILLED gI19 163
5. TOTAL DEPTH- 190
6. DOES WELL REPLACE EXISTINC; WELL? YES ❑ NO d
7. STATIC WATER LEVEL 13clow Top of Casing: 3_0 ET.
(Use "+" if Above Top of Casing)
R. TOP OF CASING IS / FT. Above Land Surface'
'Top al casing terminated at/or below land surface requires a '
LDvariance tsA NCAC 2C B 9 Y I E TEST
1(1. WATER ZONES (depth): __ 0'
11. DISINPECII(C N Type Amount
12. CASING: Wall Thickness
Depth ()Ureter or Weight/Ft Material
I;,0m r l i t, (ICI FL G 6'
limn To Ft.
Dom Tn Ft.
I3. C;ROt II _ Depth Matcrigl (.Method
l tom O Tt, 22- F1. _/0 eq,. 10 vrCCI
I1 out To Ft. Cc -runt
14. SLID EN- Itcrlli Diameter Slot Size Material
1 tom -I 1'I. in. in.
nom...------ 1. , FIin. in. _____ _____ -
15. S.ANI1/(;RiA V Et. I'A('K:
Depth Size Material
5ue�1 PvC
I min l'n FL
limn To Fl.
16 REMARKS
1 POI1LPTRY CHO 1 I' TI IA'f THIS WELL WAS CONS]
t l.ONS I RUC HON STANDARDS, AND THAT A COPY OF
SIGNATURE OF PERSO
Submit the original to the Division of IVater Quality,
27(,97-1636 Phone No, [phone], within 30 days.
R�1k —779
Topographic/Land setting
❑Riclge ❑Slope ❑Valley ❑Flan
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
I,alitudc'longiltide source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From "fn Fornrttion Description
0 5y1
.SS' 61 ue rc cn�(r
Sb' (y3^ 1c n toot
3_0;).)s.1 - 03 62109S
LOCATION SKETCH
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include the road
numbers and common road names.
Rt;CTED IN ACCORDANCE W1T11 I 5A NCAC 2C, WELL
MS RECORD HAS BEEN PROVIDED 10 TI IE WELL OWNER
SI,FRUCTINC-�
I114E 1�h Ll.-'
DATE
tdwater Section. 1636 Mz-t J ce Center - Raleigh, NC
GW-I REV. 07/2001
GRICLte,t

Submit the original in the Division of Water Quality, Gm
2 769')- 1606 No [phone], within 30 days.
2780 H 0
WELL CONSTRUCTION RECORD
North Catolina - Dep;fitment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
wrI.I. cum ItACI OR(INDIVIDUAL.)NAME (priint)'./)ecr-'y ^�(W ccrLv5 ,.�V CERTIFICATION �#//3cCi '5-2
\\IJ. i. CONrI(ACI OR COMPANY NAME ,iIDM1E•`-I t2QLL Co-'p43/4 b-ZL PHONE (3v) j1�18 —I/WO
s1111: \WE1.I. (il?S'IRUCTION PERMIT#- ASSOCIATED \\'O PERMIT#
l if applicable) (if applicable)
W E.LI- USE (Check Applicable Box): Residential R Municipal/Public ❑ Industrial 0 Agricultural 0
NInnimring ❑ Recovery ❑ Ilea( Pump Water Injection 0 Other ❑ IrOther, List Use n
Ft
W EI. 1.I.0C AIION:
Nearest Town: ,4/1.1/2f1sit CountyVLenzi
13_eOR_PA 1-0
(sruct Name. Numhcr:, Community. Subdivision, Lot No.. Zip Code)
I I1WNPR: _ c'<Rp __Fake 56 )1-oyc/ Hone,
addles
()lug /`� 11�2.�J `I
I�I t or Rou� )" •
.s /
lnc OF IOW]) SOIL' Zip Code
Ate cote Phone rumba'
i DArE:DRILLE:D e l! /03
5. -ID FAL DEPTH: 6C3d .
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO D
7. STATIC WATER LEVEL Below Top of Casing: /JP_FT
(Use "+" if Above Top of Casing)
TOP OF CASING IS / Fi. Above Land Surface*
•Top of casing terminated at/or below land surface requires a
ca ria ace in accordance with I5A NCAC 2C.0118.
9. 1IEI.DIgpm): 1 METI{ODOFTEST
10. WATER ZONES (depth): Pc
/ akin
I I DISINITCTION: Type_ CLIDA,-°e Amount ion
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Plat
(check appropriate box)
Latitude/longitude of well location
'Wm:Tees/minutes/seconds)
Lalinul_'Iogllude suurde:DiPS❑Topographic map
lchcck boil
'I. DEl''il1 DRILLING LOG
Float To Formation Description
IS7- o So )
�1D ` 7 0 r(-
_3 to - 4&) Ji4rcl G nay 6rantir
3()o93 .9'/ 6 • fl
LOCATION SKETCH
Show direction and distance in miles from at least
l2. CASING: Wall Thickness �^ two Slate Roads or County Roads. Include the road
Dcplli Dianielcr or Weight/It . Material norther and comma road names. O
CO 0
Fr(nnrI 'Io 93 Ft. Eve 5DG.al 2'c,
Prone To Ft.
Front To 111.
11, ( ;ROD /1. Depthsn Material Nd 1lclho
row . .0 I o <Y% Irt. ATcc7((�
) ._._ c,uc rd._
N. I1> FL CUnnerL
II sun' k NI Dcptll Diameter Slot Sin Material
rom- to FI. in. in.
I rum InFI. in. in. _.
I S SANDD (iRAA'IEL PACK:
D. pili Size Material
IronsI"..-..__—I't
Ircau "lu
Iti. P1iN1;\RKSi
IN)
C-11
1 1)(11IIi1 :11Y CERTIFY TI IAT TI115 WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELL
CONSTIU UCTION S FANDARDS, AND TI IAT A COPY OF THIS RECORD I IAS BEEN PROVIDED TO THE WELL OWNER
gIrz )03
SR; FURE OF PERSON CO o}ict'C{ N4fl II'1VI,E l i/ 1E; r-1 )AIL
-, ttl 11 Li
xh 'her Sect io 1, 1636 Mail Ser.ike Nee - Raleigh, NC
IW-I REV. 07/2001
L
rnr;

WELL CONS'I'RUC•I'ION 1tECORD
Net Ih Gnolinu - Department of Environment and Na1{ural Resources - I)iivisii/pinn of Water Quality - Groundwater Section
Rr.11.('(,,,,,,( I UR IINDIAIDUAL) NAME (Pint)5 sgRi vli -er ----- CERTIFICATION NM 115.
V,L I. L ('(IN 1 It.A( l OK CO>1PANV' NAME And l� _ Wet( —Co, NL-- _ PHONE q")Y64"Y4iitk
Sl Al F \A F I.I, CONSI ltln'rION I'EItiIITW
( ifat) (if applicable)
ASSOCIATED F.0 WQ Pra(PUT
no
I. A.'PLI. LISP. ICheck Applicable Box): Residential r(ilunicipahl'uhlic ❑ Industrial ❑ Agricultural ❑
Vh.nilori lin ❑ lineman y 0 IIcal Pump Water IRicci ion ❑ Olhcr CI IIOther, List Use
/BAN' —77`it
N e;lr?51 't0\\'ll // lartkV -- �Connly---cittroket_
0 t„, of
1':Iirct min- Nun,hri.- 1-wnin unity, Subdivlc;nn, Lot No., Zip Crider
lvVNIR: R.-3-try... 4 kef1 UgceINY
Addis •Ra(P3 Kr, the] Rd-
1--An s d� Strict � tong c_ a 9 4 Lita
.*,1)nng:5 Si,c. YD Zip Code
\rea "'Ile rim" nwnhef_
.1 D,vrP. DRILLED /—d�i�0�
6. DUES WEL.I. RI:M AC•E ETISIING WELL? YES 0 NO
7_ SI AIIC WATER I.IIVEL Below Top of Casing! Ala' F'r
(IJsc "+" if Above lop of Casing)
3_ T01' (-)1' CASING ISFl Above Land Surface'
• i np or casing terminated at/or below land surface requires a
%:mange in acrordanee ,sith I5A NCAC 2C.0118,
i
9. IILLD (gpm): _ MIiTIIOD OFTES'1'_11_4( _
In. WATER ZONI'A (depth): /ate —
Topo�gl' )hiciLand setting
ClPidge C)Slope ❑Valley ❑Elul
(check appropriate bolt
Latitude/longiturl of well location
35c)f,934N1 yoy.3yg►J
picgrecs' inures heconJ,0
Latilrol.. longitude source.OGPSDEopographic map
(check burl
13121Li]NG LOG
Formati m Description
Y cJ jJ'
L/leV .se. Ff ic,ic...'EC
Ann To
U • _. . 5
`S J SG3
_ems. ?s:
reca-Zwf. /c)' rf0C -&
--------- 14.w ' yuci — 'fro 0
jc0c, P- oq5
LOCATION SKETCII
II_ I)IiiINI'Ft -I ION fyl,c__- Annunt Show direclion and distance in miles fioni al least
12. I AASI>'G: Wall Thickness - two Stec I(oads or County Roads. Include tltc road
1_ Ucp'�i Dm iaeter or Weigle/Ft. rs IaL mmmbrts um :mil unon road nanles.
I 1 To i 9 :I(e.13$ f11�'=7/ ILL. —_
Ilona Tu Fl. _
i 11111l I-t, Ft.
13. UI201)f.‘ Ucpth Material \�Nlctlio 1
I - row -V -Io,�p FLPQr±. x V1^j0ct
I Him To - - -- lit.---- ---- -- - - - --. _ ___-__ t•
1 1 Y(RI.-I N_ -- Per'h Uiametet SDI Size Maier
1 au l o
b:�:'?
1 min - -_ I °
I SAND L'RAVE' PACK_ (,-,)
cp:f. Siic Material
1 mil!
16. I:I. iAl:ARKS.
lit
It.
Et.
0
w
Ph
r
Fri
�)wc ..�.-'jcruril
I I n) III'RI[1(1 ('I R I Il Y TII ;A f'I I IIS WELL WAS CONSTRt IC'TIID IN ACCORDAN('L Wllll I5A NCAC 2C, Mil,'
( ()5S lRU(-fION STANDARDS, AND; li •A COPY OF TIIISIRP'O2l) I IAS BEEN PROVIDED 'fOTIIE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING 'HIE WELL.
DATE
So Midi the oril,in:,l to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh,
76nv In'n Phone No. (')I')) 733 3221, will}in 30 days. t GW-I RI:V07I2 101
Inn

r8'18
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 3295
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELL CONTRA(TOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
WELL USE (Check Applicable Box): Residential I MunicipaVPublic ❑ Industrial 0 Agricultural 0
Monitoring El Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPEIY
HANGING DOG RD & ED GRAVES RD
(curd Name. Numbers, Community, Subdivision, lot No., Zip Code)
County CHEROKEE
1. OWNER: TODD MOERCHEN
Address 908 HARBOR BAY DR
(Strict nr Route No. )
TAMPA, FL 33602
City or Town Shur Zip Code
727 T. 638-9744
/ ern rode- Phone numha
4, DA'1E DRILLED 07-30-2003
TOTAL DEPTH: 605'
6- DOES WELL REPLACE EXISTING WELL? YES ❑ NO IKI
7. STA ]C' WATER LEVEL Below Top of Casing: 90 ET.
(Use "I" if Above Top of' Casing)
R. 'TOP (II' CASING IS 1 FT. Above Land Surface"
•1'np of casing terminated at/or beMw land surface requires a
variance in accordance wllh ISA NCAC 2C .0119.
9. YIELD(gpna): 6 METHOD OF TEST AIR
10. WATER ZONES (depth): 240'
I . I)ISINFP.CTION: 'Pepe CHLORINE Amount 100 PPM
12. I'ASIN(i: Wall Thickness
Depth Diameter or Weight/Et. Material
from ll To 80 FL 6 1/8" SDR 21 PVC
I'nmt__ _.— -- Ie------- Et.
I rom _ To Ft.
17, (;ROUT: Depth Material Mcthrod
From 0 To 20 Ft. CEMENT GRAVITY
From _ To Et.
14. SCREEN: Depth Diameter Slot Size Material
Prom To FI. in. in.
Irons To Ft. in. in.
15. SAND GRAVEL PACE:
Depth Size Material
ITnnt - To Ft. -- -
.----
Flom ---To------ Ft.
16. REMARKS:
'I opographicJLand setting
LT Ridge ❑Slope ❑Valley ®Flat
billed( appropriate box)
Latitude/longitude of well location
I degrcesiminutct/seconds)
Latitude/longitude. source:OGPSOTopographic map
(check Ina)
DEP'ftl DRILLING LQG
From _._--.la Formation Description
0' TO 80' RED CLAY & GRAVEL
80'T0605' GRANITE
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads nr County Roads. Include the road
numbers and common road names.
I
I DO HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE. win I ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT AAOPY OF Tuts RECOf) IIAS BEEN PROVIDED TO TIIE WELL OWNER
y _ 7-J0-.2U63
SIGNATCITNG THE WELL DATE
RE OF P
Submit the original to the Division of Water Quality, Gro
27699-1636 l'hune No. [phone], within 30 days.
L
t4E;SerliodJ 6.fi \pnjl S rr,-1
it
fP
Ji.
ter - Raleigh, NC
'-1 REV. 07/2001
GSOUNO'.",'LITER SECTION

273017
WELL CONSTRUCTION RECORD
North Candina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME wino LARRY F. JONES CERTIFICATION a 3295
WF,I.I. CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE a 1828) 837-8008
STATE WELL CONSTRUCTION PERMFT0 ASSOCIATED WQ PERMIT('
(if applicable) (if applicable)
i. WELL USE. (Check Applicable Box): Residential In Municipal/Public O Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
903 DIE BEND RD
County CHEROKEE
(Street Nmne, Numbers, Community, Subdivision, Lot No., Zip Cede)
3. OWNER: BRUCE & CARROL TURNER
Address 235 WHISTLER SPRING COURT
(Street or Route No.)
JACKSONVILLLLE FL 32225
City or Town State Zip Code
( 904 )- 237-0561
Arco code- Phone number
4. OATE? DRILLED 08-13-2003
5. TOTAL DEPTH: 70T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 160 FT
(IJse "✓' if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
'Top of riming terminated at/or below land surface requires a
variance in accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 12 METHOD OF TEST AIR
In. WATER ZONES (depth):
'Fopographic/Land setting
ORidge ®Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(derive/minutes/seconds)
Latitude/longitude sotircc:OGPSOTopographic map
(check him)
DEPTH DRILLIN LOG
From To Formation Description
0' TO 20' RED CLAY
20' TO 40' GRAVEL
40' TO 81' RED CLAY E. GRANITE
81'TO707' GRANITE
11. DISINFECTION: Tvpe CHLORINE
12. CASING.
Depth
From0 To 81
From To
From To
l3. GROUT: Depth
['coin 0 To 20
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 1/8" SDR 21 PVC
Ft.
Ft.
Material Method
Et. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
Prom To FL in. in.
15. SAND/GRAVEL, PACK:
Depth Size Material
Prom To Ft.
FrolnTo Ft.
Ft.
16.RFMARKS:
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.
rJ,
0
I IX) IIER EBY CEIEII IY'Ili A'I'IRIS WELL WASCONSTRLICTI--.D IN ACCORDANCE. WI Ell 15A NCAC 2C, WELL
CONS 11211C HON STANDARDS, AND THAT A.PY OF TIBS INiCll9Rf7�I-IAS BEEN PROVIDED TO THE WELL OWNER
r v�
CINGTHE WELL DATE.
Submit the original to the Division of Water Quality, Groundwater Section
27699-1636 Phone No. (9191733-3221, within 30 days. j;dl
��1{I
163. Ma S
Center- Raleigh, NC
GW-I REV. 07/2001

WELL CONSTRUCTION RECORD
North Cal linu - De! ailment of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CON7ltACl Olt (INDIVIDUAL) NAME (print) 3CC:'j ltJce P 2. CERTIFICATION#/mod(4.57�/
11E1.1, (ON1121C"1 OR COMPANY NAME /AbkL VJe CoMN4�yl IMc- PHONE p I•� 'It 55-17//�//Q
5'I,\Tt': \CELI. ('ONS'I ItICI ION PEIUVIIT#
(if applicable)
273016
ASSOClA'I'EI) WQ I'EILM ITd
(irapplicable)
1. \V1 .1. (1SIi (Check Applicable Box): Residential V Municipal/Public 0 Industrial ❑ Agricultural 0
.Monitoring ❑ Recovery ❑ Ifeat Pump Water Injection 0 Other ❑ IfOther, List Use
2 WEI.1. LOC\IION:
Nc,nc+l Town. 411l1_k/ County C%rl'R,okeEs,_
(Saari Name, Nm((nn�hecs. Conmumiiy, Subdivision, Lot No., Zip Code)
S OWNER: [�V�- .ZOTko ✓I
Address 3l6 S C.ERcLC
(Street or Route No.)
___Awylv nl
orr-n/ St Zip Cede
Y31 O1-`-1-19;
Area redo- Phone number
.1 DATE DRILLED eJ_/3 /0.3
5. TOTAL DEPTH: Lia2 (D;
6. DOES WELL. REPLACE EXISTING WELL? YES ❑ NO Cie. 1i30- 1 Y
7. STATIC WATER LEVEL Below Top of Casing: 7S FT. I �� -
(Use•+ if Above Top of Casing)
5. 'f01' OE CASING IS I ET. Above Land Surface* 110_ `lv>
•lap o1 casing terminated auor below land surface requires a
variance in Accord ante with 15A NCAC 2C .0118.
9. YIELD (glint): J METIIOD OF TEST
1 n WA]ERZONES (depth): 1 70
00p1 LOCATION SKETCH
11 DISINFECTION: Type CA haftru Amount _ 700 �1 rt. Show direction and distance in miles from at lead
12- CASING: Wall Thickness J two Slate (toads or County Roads. Include the road
I )epth L Diameter or Weight/Et. Material numbers and common road names.
Dem 11 n, y 1 Ft.
Iron To _ Ft.
Prong --- .I'n..-_._..._ Ft.__..---
13. liA<hll f: Depth Material r�Metlied
Frew Q T1, oil I-t. �C0.r NV/'et)
Cstinn
I.I SCRIiLN: Depth Diameter Slot Size Material
Don lb ht. in.
From _.._ T,, I'(- ..._ in.
Is SAND/(iRAVI I.I'ACK:
Dcph Size Material
I ruin I Ft.
AA N 718
Topographic/Land setting
[Midge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrecs/minutes/seconds)
Latitude/longitude sou rce:OG PS❑Topograph i e nap
(check hox)
DE:PTII DRILLING LOG
Formation Description
5011
Jr slue r 1►-e
t (; rosin Ka
k
2ai pv6
Prom Io Ft.
16. REMARKS:
Prom To
-
9e
,' - JOY
�- Ia0
3C ?trl - 1
11)f) HEREBY CFRI IPY TITAT THIS WELL. WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCT! ION S-( ANDARDS, AND THAT A C0I'Y OE •I I -ITS It • • . TO THE WELL OWNER
C' re- Wo (4�} 8�13/�j
a~ SIGNATURE OFPERS(t L 'SLREICTING IIIL \YELL. I DATE
Submit the original In the Division of Water Quail'. iu cI utter Section, 1636 M
27699-1616 (`lone No. [phone], within 30 (lays.
GRCU''n fR SECTION
ASHEViLLL LI_u;.,idi+l_ UH-ICE
et ice Center- Raleigh, NC
GW-I REV. 07/2001

278013
2. \\T E I.I. 1 O('.All1) (d:
Neal esl l own: ._.l�l?r1c [U.ee' County
ASSOC-IA-IFI)'' 2 IEIlall 111
IStini Nano:, NNn7mhcr-. I low miily. Subdivision. Lad No., 711p ICotlel
1 OWNER: 17t�j3C).J el- l�;J.Nt' l l E'_ I-1 l�'FI 1
Add'ess 7Po �'1\_ri---)52 .
piiori of It Dolt No.) c
1J(�4,I.SS•10w.Y1I /Ll�: .(7v6 /02
l ilv w I.„ $dale Zip Code -
13z3) 55.3� 1
Airy rude I'bwme onndre`
d. I)ATI?tiltlLl fl) p /_f` / .3
5 TOTAI.1 61111: /.
6 1OI[S WRI,I. REPLACE. EXISTING WELL? VEST' N(1 ❑
7 Sl Al IC' WAlI!It I.I'.VEL Below Top orCasiug' V__�%;-ET.
(Use "t" it Above lop of Cnslnr9
l (11' OF ('ASIN(i IS L 1-T . Above Land Sotfhce•
WELL CONSTRUCTION RECORD
Not li (';u'ohm - Uep:atnicnl of Environment and Nato aI Ite uaces -.Division of \\'•del Quality - Groundwater Section
4_1 4Lt,v 4V. )curv-7 CF..R'r IFIGTION Ir ��//���J 3Gl!,,"'
!Uzf/ ay, J-1C I'IIONE M I3tI 771b`T
1' I t.I. t'IrN I RAC I(IIt (INDIVIDUAL) NAME (Print)
I 1.1 1'IIN 11t,1(111n (-(I\I10\N1'NM14; ,(/4✓11//)
SI All. \11i1.1. ( ISS 11t1'( 1I0N I'FIta11TN
ti(applicit del I (ir applicable)
I. WE1.I, IISE. (Check Applicable Uox): Residential Ill Municipal/Public ❑ Industrial ❑ Agricultural O
Mnniloring 0 ltecutely ❑ Ileal I'uinp Water InjeclInn I;] Other ❑ I1 OIhro. I.isl Use
7), // 2 66
�• , i �/Laful scIIR,'
Topitgra I I( 6
Llltitigc ftgglope ❑Valley Mal
It beck npplopi ielc Kos)
1.:1il11e/I01igi15de t) '\cell Ioc:liun
3503_5 � v�i - 57. 9q of
(ilrplecdoiinij sk¢onilt)
Luilulc'loogiti lc sow cc:OGl'S❑ Topographic map
(dteck bop
DI:I'111 DIRILLINGLOSI.
1: 'Ifolncdiol Description
am n
Ids .27,j' //id h nJ 6 CorA,'fG
.27,I7 322-7- /Ial s,« l,�t
• l ep nl raJn4 lcunloatcd noor brlow lend turrnte requires
,:viance lit nctord:lure ,tint I5A NCAC 2C .111111, / �j
9. 1'IIfLDIgpmP.--t3_._("IE1IIODOFTEST 4ir Y timf _ _--/ S(/'�1y 7
In. \\'ATER IONFS (depth): ado ' — ,2n25' 301 fit r23 6, 4)z7 '''
Lou A'TIVN SKUTCII
11. I)ISINI l (: FION: I\'lit (///%/i Aniotlbt ____,C,:tyQ_f; Slio v dilcctinu and distance in miles front at least
12. CASING: Wall Thickness ' 0 Iwo Slalc (toads or County Roads. Include the road
Dcplli MoulderOr \Ve gltl/I'I. ( :Oct ill liilinbcls anti conmloti load names.
liuiii.+--To_LS' . H. 64-,e Sik,/ _rVC-
rll,i In IT
13 GROG I : Depili �r hl; c�l•ial `/ Mir Q
I loin _. (:�__ I'"..a V _ ri Ake c,�Nli _ _Iiin _.C<7Y'tGC
Ilnm I'n rt.
it G'Iti.F.N- Depth I)i:nncicr Slat Sine maim iai
11. - -M.
FL . M.
I non In
I owl tit ,
15. SAND. 1RA VI 1 I'AI'K
lit pill Size
1111111 - 1(1 - , Il-
111111 to .
I1, ItF.i'.1,\ItR.S'.
7
7
iu
I\tracrial
21. er —
II 11) III'Rlll)1 ("I.1r111V I11.'\1'IIIIS\\'ILI,WAS CONS! RIIC I ED IN ACCf)1tl)Ail(l- O'IIII ISA PJ('AC 21.", \VI I.I,
(()JS I It 11(.11ON,SIANDARUS AND'IIIAT A COPY OF I111S I)rCOI(DllASII I'I1N l'R()VIDII) IO I I IF WELL OWNER etf ��_-- �9/D s
SII;NAlUItF OF PERSON IJAIE
Suluui( Ibc or'phial In the Division or \Paler (lualily,
-'76ou 1616 ('hone No. 1')1'1) 713-3221• n ilhiu 111 days.
/T) 1)1}1) d CW4j
f, JdL r�fi i/'
_ 1 kJ,II
Stsllmi. Ie.In Mall rrh) -e Ccnlcr - Italriply N('
(1W-1 It F.V. (17/2111)1

WELL CONSTRUCTION RECORD 2 7 8 5 r7 8
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
CERTIFICATION,' 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE,' [phone]
STATE WELL CONSTRUCTION PERDIITf
(if applicable)
ASSOCIATED WO PERMIT,'
(if applicable)
1. WELL USE (Check Applicable Box): Residential VI Municipal/Public O Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery O Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
9 WIG KING RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: TOMMY HIERS
Address 1702 PINECREST CT.
COCOA,
(Sheet or Route No.)
FL
32922
City or Town State
( 321 )- 258-9706
Arca code- Phone number
4. DATE DRILLED 08-28-2003
5. TOTAL DEPTH: 225'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top or casing terminated a(Jor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST AIR
10. WATER ZONES (depth): 190'
11. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING:
Depth Diameter
From 0 To 74 Ft. 6 1/8"
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Sizc Material
From To Ft.
From To Ft.
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
16. REMARKS:
Topographic/Land setting
/ Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 30' SAND
30' TO 65' RED CLAY
65' TO 74' GRANITE
74' TO 225' GRANITE
LOCATION SKETCH
Show direction and distance in miles from at least
two Slate Roads or County Roads. Include the road
numbers and common road names.
1 DO HEREBY CERTIFY THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE \VITI I I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT h COPY OFFIIS RE5E)�U IIAS BEEN PROVIDED TO TILE WELL OWNER
SIGNATURE
TRUCFING TIIE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Sen
27699-1636 Phone No. [phone], within 30 days.
DATE
rl REV. 07/2001

27860
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources Division of Water Quality - Groundwater Sectionio7
WELL CONTRACTOR (INDIVIDUAL) NAME� 7(p`rtnt) FR8A/7 / - V/G! Vr C CERTIFICATION *3/7S
WELL CONTRACTOR COMPANY NAME f7 V&?.S eta r a r�%eICl/A/6 PHONE i' (2*. 7g,51/66
STATE WELL CONSTRUCTION PERMTr# ASSOCIATED WQ PERMITS
if a, linable if •rlicable
I. WELL USE (Check Applicable Box): Residential C1 Municipal/Public 14Y Industrial 0 Agricultural 0
Monitoring 0 Reoovety 0 Heat Pump Water Igieation ° Other 0 If Other, List Use
2. WELL LOCATIS1tJ�:
Nearest Town: MOL?P//P' County C!/H?D E
&JjLT1r32NC-5.S
(street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: QLEA/ a/c
Address ass Au..64/ /11)
Sttoct ar Ro No.)
C o?fwtllt-L f&v,'/. 317/3
Tyor4C(ce- $ i l4 Zip Code
Area code. Phone number
4. DATE DRILLED ' 4 - 03
.5, TOTAL DEPTH' h 7 5 -
Topographic/Lan4.ettting
1ZD ClRidge °Slope alley ❑Flat
i (chack appropriate box)
Latitude/longitude of well location
/` .3s rte. . 005 'W Oaar/ 8 -97/
(degtaa/minutesheeoads)
Latitude/longitude sotiice:OGPSOTopographic map
(check box)
PfULLING LQG
Formation Description
6/04C€ Clay
TeZt/ Weic3adifog Art:
aaav&m
ooc
& X/ GVel [0f 14:
RPTH
From To
0_ -9
4-, 9
9-�5
4,3
6. DOES WELL REPLACE EXISTING WFI.T 7 YES NO 1� 3 _ / 8
7. STATIC WATER LEVEL Below Top of Casing' C_FT. 3�_ /60
(Use w'IrAbove Top of Cuing) �r; S. TOP OF CASING IS 2. FT Above Land Surface"
'Top of cuing terminated atlur below land sudue requires t
variance la aeeordnce wish SSA NCAC 2C.oilg.. ? - /642.7—G?Pl oUsp
9. YIELD (gpm): ?el METHOD OF TEST /9/R 4&' -405-
10. WATER ZONES (depth)://L0 .3&' 483 336
/a4E9es eocePtir/oe,Oiu
,W7H Amount -/ h /b
Wall Thickness
Pinner or Weight/Ft. Material
Ft.fo3/,Q /eg Si�cL
Front— To Ft.
From_ To_,_, Pt
13. GROUT: Depth Material Method
Frorn T3- Ft, CCasl S- ,24;i4s9
From _ To Ft.
14. SCREEN; Depth Diamota Slot Size Maretial
From, To Ft,_in in.
From_.___ -To Ft.®_jn, in.
15. SAND/GRAVEL PACK:
Depth: Size Material
From To Ft.
From To Ft.
11. DISINFECTION: Type
12, CASING:
Depth
Fromm�� To -Z
Hr3C-c?S
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.
igeric
flea, re,c.ic
a
0
c.rt
c
0
c •
rri
2m
o
=o
cn
rTIDD
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTIjL LION STAND , ANp THAJ A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
2--6 03
OP PERSON CONSTRUCTING THE WELL DATE
SIONA
Submit the original to the Division of Water Quality,
27699-1636 Phone No. [phone], within 30 days,
idraiatanueio4161 iliil
Center - Raleigh, NC
GW-1 REV. 07/2001
GROUNCI 'ATE° SECTION

278623
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
%XELL CON)RAC*" OR(INDIVIDUAL) NAME (print) '/ //MJ/I'75 CERTIFIC�Ay�T//I`ONa dS72--,/
WEI.I, CO:Na )[ACTOR COM I'AN\' NAME —1G�`� M -U- 4( C-0 I(S.G PIIONE ti lN(y ti(ou-4`44°
STARE WEII. CO:NSI'RUC'TION I'ERMITti ASSOCIATED \VQ l'EItMITk
(if applicable)
(if applicable)
WELL USE (Check Applicable Box): Residential iQ Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nlonitoring ❑ Recovery
2. \VELL LOCATION:
Nearest Town: /1'( t4
❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
County L.J1o2-(.1<E _
(Street Name. Numhers. Comm 1114. Subdivision, Lot No., Zip Code)
3 OWNER: ) hnl k'_^)Z
Address 179 SN an-1i 1-(�
(Street or Route No.)
( WTI Ai 90
City orlt vn State Zip Code
l<Ciz-W)- 837-- CUB- %)
Area code- !Rion numbss[�
4. DATE DRILLED 7 •-03
5. TOTAL DEPTH: 3 2)
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top ofCasing: tJ. FT.
(Use "+" if Above Top of Casing)
S. 'f01' OF CASING IS FT. Above Land Surface'
`Top of casing terminated at/or below land surface requires a
variance in accordance \r ith I SA NCAC 2C .0118.
9. YIELD(gpm): „l�} METHOD OFTEST eft
10. WATER ZONES (depth)::
I I. DISINFECTION: Type CX7ca Amount /00 pp�.
12. CASING: - Wall Thickness
nr 'eiehUFl. Material
Depth Diaineeler
From 4] To / Ft. G• /vfy- -) . -il five_
From To Ft.
From To Ft.
13. GR.OUT: Depllt gqNialeriul lclhot
Prom To�(� Ft. /ar/ Mg(
9N
From To Ft.
14. SCR FEN: Depth Diameter Slot Size Material
From To H. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From to
From fo
Size
Ft.
Pt.
Material
4 - c)
Topographic/Land setting
❑Ridge ❑Slope ❑Valley 'frSk lal
(check appropriate box)
Latitude/longitude of well location
(degrees/m int lestsec ands)
Latitude/longitude soiree:❑GPS❑Topographic map
(check bore)
DEI'Tli DRILLING LOG
prom l o Formation Description
/h'3-i 43-
6u�
uZS1.)=2 r/bit-
152- 3? 7 e �+ c3 J U C
3C)� C -
Q/z
LOCATION SKETCH
c
Show direction and distance in miles from' Iea
two Slate Roads or County Roads. Include ro
numbers and common road names.
-o c
( o<
16. REMARKS:
I DO HEREI3Y CER IlFY TIIAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE AVITI I I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, ANI) TIIAT A COPY OF TFIIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
SIGNfyi012E0
/r�� i7"a-o3
ERSON CONSTI
Submit the original to the Division of Water Quality, Ground \
27699-1636 Phone No, (919) 733-322I, within 30 days.
GROL'.NLIWATFP .9Fr1-1n0i
Raleigh, NC
REV. 07/2001

13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
27862°
WELL CONSTRUCTION RECORD
North Carolina - Department of Enviromnent and Natural Resources - Division of Water Quality - Groundwater CERTIFICATION #tion
WELL CONTRACTOR (INDIVIDUAL) NAME (print) MATTHEW D. BROWN
3036
WELL CONTRACTOR COMPANY NAME YADKIN WELL CO., INC.
PHONE a (336) 4
ASSOCIATED WQ PERMIT#
STATE WELL
fa livable) ON PEAM1IIT# ifa ficablc
(ifa livable
I. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
TARHEEL - WARREN DR TO HALO LN
(Street Name, Numbers. Community, Subdivision, Lot No., Zip Code)
3. OWNER: MIKE GUTHRIE
Address P.O. BOX 295
(Seto or Route No.)
MURPHY NC 28906
Zip Code
City or Town State
( 828 )_ 494-3804
Area code- Phone number
4. DATE DRILLED 08-21-200_-__--3_---
5. TOTAL DEPTH: 802�---
6. DOES WELL REPLACE EXISTING WELL? YES O NO
El
7. STATIC WATER LEVEL Below Top of Casing: 125' FT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of using terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 3 1/2 METHOD OF TEST AIR
10. WATER ZONES (depth): 650'
1 I. DISINFECTION: Type CHLORINE
12. CASING:
County CHEROKEE
Depth Diameter
From 0 To 21/2 Ft. 61/8"
From 21/2 To 289 1/2 Ft. 6 1/4"
From To Ft.
Material
Ft. CEMENT
Ft.
Diameter
Ft. in.
Ft. in.
Size
Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
.188 STEEL
Method
GRAVITY
Slot Sizc
in.
in.
Material
Material
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
SOL/ CLAY/ SAND
MED. HARD GRAY GRANT
SOFT - MED GRANITE
MED. GRAY GRANITE
SOFT WHITE GRANITE
MED. GRAY GRANITE
DEPTH
From To
0' TO 285'
285' TO 360'
360' TO 390'
390' TO 590'
590' TO 680'
680' TO 802'
BIT SIN 30224-63
LOCATION CH
Show direction and distance in miles front at (east
two State Roads or County Roads. Include the road
numbers and common road natnes.
SIZE OFF @ 6.060
�t
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TFIAJ;A COPY OF TIIIS RECORD I IAS BEEN PROVIDED TO THE WELL OWNER
tot__
SIGN TURF OF PERSON CONSTRUCTING THF. WELL
Submit the original to the Division of Water Quality, Groundwa
27699-1636 Phone No. [phone], within 30 days.
DATE
GROUNDWATER SECTION
ASNEW I F RFm;lnuai nmro
Igh, NC
07/2001

WELL CONSTRUCTION RECORD 273618
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME (print)
LARRY F. JONES CERTIFICATION It 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC.
ASSOCIATED WQ PERMIT#
STATE WELL CONSTRUCTION PERMIT/I
(if applicable)
(if applicable)
PHONE N [phone]
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pmnp Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
County CHEROKEE
HIAWASSEE DAM RD
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOE MICKENS
Address 3040 HIAWASSEE DAM ACCESS RD
(Street or Route No.)
MURPHY, NC
28906
City or Town State Zip Code
( 828 )- 644-5539
Are, code- Phone number
4. DATE DRILLED 09-03-2003
5. TOTAL DEPTH: 245'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Ell
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "t" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Tap of casing terminated allor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST AIR
10. WATER ZONES (depth): 205'
I I. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 82 Ft. 6 1/4"
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Prom To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
.188 STEEL
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
tdelres/minules/secomis)
Latitude/longitude source:OGPSOTopographic map
(check hox)
DEPTH DRILLING LOG
From To Formation Description
0' TO 40' RED CLAY
40' TO 60' SAND
60' TO 82' GRANITE
82' TO 245' GRANITE
From To Ft.
16. REMARKS:
I DO IIEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT,KVOPY OF THIS IjF.5'ORD HAS BEEN PROVIDED TO THE WELL OWNER
—3—C 3
SIG TUR PERSONc j STRUC'FING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, N
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2
BIT SIN 30224-63 SIZE OFF @ 6.060
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.
7
J
co
0
Cn
m
co
xa
co q
0
O
or-1
crrl
z
orn
a_ m
m�
2J
tr o
m�
r
ti
C,J7
Cn
0 <
CO
r C
rz
mO
bt La
o
m
cn

WELL CONSTRUCTION RECORD
,-rQQQQn
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - GrduntivJatel ection
n CERTIFICATION #�U0(i
WELL CC:':T-osr'1'OR (INDIVIDUAL) NAM.Eyy(pr/lnt)Li(�.fWif?a K� � `� �\q��
WELL CONTRACTOR COMPANY NAisia �//ilhot 1.12,ol/ d ,I/,>79
SSOCL T_' D WQ PERMIT"
STATE WELL CONSTRUCTION PERMIT# A(if applicable)
(if applicable)
PHONE # feuv)137-2997
1. WELL USE (Check Applicable Box): Residential Oz.-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Mkt (Oh'.
loWIf,-l-lc, 2A,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
COUIltyniP rokeP
3. OWNER:Q u\ r \fl
Address r,L.LA 0PN-if In c
(Street or Route No.) i,6tiltaco
City or Tow State Zip Code
( )-
Area code- Phone number
4. DATE DRILLED %- % - D Z
5. TOTAL DEPTH: /r-/' '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO E-
7. STATIC WATER LEVEL Below Top of Casing: OD / FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): h METHOD OF TEST 412
10. WATER ZONES (depth):
11. DISINFECTION: TypeVAVN p o tip 6 Amount IS
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft.
From_ _J2—To 3ln' Ft. (o .2 S .S/ O 1
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To ,20 Ft. fa /%n d ere ssvrP
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft, in. in.
15. SAND/GRAVEL PACK:
DepthSize Material
From To I-t.
From To Ft.
Material
Pi"(
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS
CONSTRUCTION STANDARDS, AND THAT A COPY 0
SIGNATURE OF PERSO
Submit the original to the Division of Water QualityGroupi
iiKe0.1.tf Thnne No. [phone], within 30 days. A'.-'''
Topographic/Land setting
❑Ridge ❑Slope [Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
t�l'>S°'oY Sto"l vJ S°e°t SB': 3S
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Fo ton Description
d - Ho ' \I)Ol lkt� Pr
a,0 /vs' .,,, a.S/G»
0
"n �T
rr
LOCATION SKETCH t oti
Show direction and distance in miles from at Rt
two State Roads or County Roads. Incice the dad
numbers and common road names.
L j nVla+ t
(iourd
ecaviA
}
0
U1
CO
cfl
r :a
0
—4
/ JJZ11
I o
1331
15A NCAC 2C, WELL
bED TO THE WELL OWNER
STRUTTING THE WELL.
DATE
Apr Sict7on,1636 Mail ervice Center - Raleigh, NC
i rGW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
nea.,rp�n1
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - GrburtdWtiatdr•Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ka.n'l t?� <vt S t �-)AGflYl
CERTIFICATION #
WELL CONTRACTOR COMPANY NAME ifil I I)( (- tn'1F) I ( AC, I)' /l j PHONE # (C>>) Y31- � 99Y
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential 0--Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2 WELL LOCATION:
Nearest Towu:WCRQkk1, County cjnPfc LP_
CY),SSior' Rd Qecrc\-Jicoe
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: W t t.Ll frAe,,,,tj-1- .TR-.
Address 2-0 ivi (T\\SS\or\ PP.
(Street or Route No.) �qn ��
felUX Q�\U\ l "I
City or Town State Zip Code
( Area code- Phone number
4. DATE DRILLED Ft -Co - U 5
5. TOTAL DEPTH: ;)t(S
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO I11-
7. STATIC WATER LEVEL Below Top of Casing: l0n' FT.
(Use ••+" if Above Top of Casing)
8. TOP OF CASING IS k FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 1.1 METHOD OF TEST Q 2
10. WATER ZONES (depth):
11. DISINFECTION: Type\'h Qt211P I-S
12. CASING:
Depth Diameter
From,_12._ To . (-1B' Ft. (n,l
From To Ft.
From To Ft.
13. GROUT:
From (')
From To Ft.
14. SCREEN: Depth Diameter
Ft. in.
in.
Amount \ 5
Wall Thickness
or Weight/Ft. Material
/Yg S/NE
/
n
Depth ateal
To .2n ' Ft.
From._ To
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
fresSt14�
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
Topographic/Land setting
❑Ridge 11181-ope ❑Valiey ❑Flat
(cheek appropriate box)
Latitude/longitude of well location
NI?Cb'43" )W2)2"'s . 4
(degrees/minutes/axonds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To fiormation Description
(� - .2 yD J-, eo r/Gj/
aUD' .76,c (;°,7,� e
o
0_
rr'1 Cr1-1
LOCATION SKETCH o¢
Show direction and distance in miles film ajJst
two State Roads or County Roads. Include tIRIDad
numbers and common road names. o m A
n
(J1
CC) co
z
1 DO HEREBY CERTIFY THAT THIS WELL WAS CON
CONSTRUCTION STANDARDS, AND THAT A COPY
SIGNATURE or i ERS
Submit the original to the Division of Water Quali
27699-1636 Phone No. [phone], within 30 days.
OCT_
TRUCTING THE WE
5A NCAC 2C, WELL
D TO THE WELL OWNER
5 6 O z *V?
DATE
Service Center - Raleigh, NC
C-;-1 RP.V. 07/2001

WELL CONSTRUCTION RECORD 2 e7 3 8 33
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prino LARRY F. JONES CERTIFICATION # 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # ( 828) 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
VALLEY RIVER MTN.
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No.. Zip Code)
3. OWNER: KATHLEEN BOUGHER
Address 1038 DAYLILY DRIVE
(Street or Route No.)
MURPHY, NC
City or Town State
( 828 )- 835-8834
Area code- Phone number
4. DATE DRILLED 08-20-2003
28906
Zip Code
5. TOTAL DEPTH: 345'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 80' FT.
(Use "t" 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 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST AIR
10. WATER ZONES (depth): 280'
11. DISINFECTION: Type CHLORINE
12. CASING:
From 0'
Depth
To 100'
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0' To 20' Ft. CEMENT
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Method
GRAVITY
16. REMARKS:
Topographic/Land setting
❑Ridge 0Slope ®Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 60' RED CLAY
60' TO 85' BROWN DIRT
85'TO 100' GRANITE
0
W
N
nt
—o
0
20
"1
LOCATION SKETCH t e'er
IV gn
Show direction and distance in miles from at least >°
two State Roads or County Roads. Include t}Rroadmo
numbers and common road names.
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
_, 8�-D3
SIGNATURE OF
UCFINGTIIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 MAII Service Censer - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. '.. 1
NZ
ma
1
ri
LGW-I REV .07/200
L
( 7OI tER SECTION
Aa E`.iLLE RLCIONNL OFFICE

City or Towm Stale
( 407 )- 679-7382
Area cock- Phone number
4. DATE DRILLED 07-30-2003
5. TOTAL DEPTH: 165'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO RI
7. STATIC WATER LEVEL Below Top of Casing: 15 PT.
(Use "+" if Above Top of Casing)
5. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of easing terminated sVor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST AIR
10. WATER ZONES (depth): 95'
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AN
D PUMP CO., INC.
277482
Division of Water Quality - Groundwater Section
CERTIFICATION N 3295
PHONE N [phone]
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WI) PERMITN
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential lEa Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
I.
2,
W ELL LOCATION:
Nearest Town: MURPHY
County CHEROKEE
GREASY CREEK RD.
(Street Name. Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: STEVE ANDREWS
Address 1310 GLADIOLES DRIVE
(Street or Route No.)
WINTER PARK, FL 32792
hip Code
1 I. DISINFECTION: Type CHLORINE
Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 20 Ft. 6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Et. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From__ To Ft.
'Topographic/Land setting
❑Ridge ['Slope ❑Valley ®Flat
(check appmprinte box)
Latitudc/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographie map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 20" BLACK DIRT
20' TO 165' GRANITE
0
LOCATION SKETCH
Show d'reel ion and distance in miles from at -least "_
two Slate Roads or County Roads. Include thedoad ;?
numbers and common road names
16. REMARKS:
1 DO ISERERY CERTIFY THAT THIS WELL WAS CONSTRUCIF.D IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND MN COPY OF LIWLEC HAS BEEN PROVIDED 10 THE WELL OWNER
j 1-_3o- U3
SS ATURE PF,RSO COMA ICTING THE WELL DATE
Submit the original to the Division of Water Quality, Groud war -Section, 1636 Mail Senice:Gipt4r-Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. ) 1 ----- -- ._._._ _ IGW-I REV. 07/2001
i

277480
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL. CONTRACTOR (INDIVIDUAL) NAM (prang LARRY F. JONES CERTIFICATION M 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. pitONE # 1828) 83743008
ASSOCIATED WQ PERMITS
STATE WEL1.f:ONSPERMITS (if applicable)
(if applicablcablee))
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
KRAMER'S KNOB TO DAFODIL
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Corte)
3. OWNER: BILL PENN
Address 5109 N. VAUGHN RD
(Street or Route No.)
PLANT CITYFL 33565
Pity or Torn State Zip Code
( 813 )- 986-3579 ..
Arch code- Phone number
4. DATE DRILLED 07.26-2003
5. TOTAL DEPTH: 707'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO Rl
7. STATIC WATER LEVEL Below Top of Casing: 656 __FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface'
'Top of cuing terminated abor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): __ -- METHOD OF TEST AIR
I0. WATER ZONES (depth):
County CHEROKEE
I I. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 34
From To Ft.
Amount 100 PPM
Wall 'Thickness
Diameter or Weight/Ft. Material
Ft. 6 1/8' SDR 21 PVC
'topographic/Land setting
❑Ridge ®Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3508.358N/8403.594W
(degrees/minutes/seconds)
Latitude/longitude souree:K1GPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 34' RED CLAY
34' TO 300' GRANITE AND QUARTZ
300' TO 707' GRANITE
From To Ft. ---
13. GROUT: Depth Material Method
Frotn 0 To 20. _ Ft. CEMENT GRAVITY
_. From To Ft.
14. SCIt13EN: Depth Diameter
From To Ft. in.
From To Et. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Slot Size
in.
in.
Material
From To _—_— Ft.
From Itt _ _ Ft.
r-V
W
a
0 c
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include than, ad
numbers and common road names.
c
16. REMARKS:
1 DO IIER EBY CERT EFT '1 HA 1. THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND T[ikj A COPY O,TIES R. . RI) HAS BEEN PROVIDED TO THE WELL OWNER
itJ OL __ - '-0
Q--
FPER NC ERUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Croundlvttt S,ptndn, 1636 Mall Service 7G�{ iL REVgh, C 1
27699-1636 Phone Nn. [phone], within 30 days. i j
iJ L 1.
j
--- lIOiJ

277479
2. WELL. LOCATION:
Neanst Town: ANDREWS
WHITE FARM LANE
(Steel Name, Numbers. Cormnunity, Subdivision, Int No., Zip Code)
3. OWNER: HARDY LUTHER
Address 3791 FAIRVIEW RD --
(Street or Route No.)
ANDREWS, NC 28901
City or Town State Zip Code
( 828 )- 321-5957 _
Area code- Phone number
4. DATE DRILLED 07-17-2003
5. TOTAL DEPTH:_205
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top ofCasing: 20
FT
(Use "u" if Above Top of Casing)
8. TOP OF CASINO IS _ 1 FT. Above Land Surface'
"Top of casing terminated at/or below land surface requires
variance In accordance with ISA NCAC 2C .0118.
9 Y IEI D (gpm): 20 _ METHOD OF TEST AIR
10. WATER ZONES (depth):
WELL CONSTRUCTION RECORD
I' D rt t of Environment and Natural Resources • Division of Water Quality - Groundwater Section
North Caro
ma - spa men CERTIFICATION N 3295
WFI 1 CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WE i.1. CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP CO., INC.
PHONE [phone]
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMITN(if applicable)
(if applicable)
I . WELL USE (Check Applicable Box)' Residential Ea Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
"FopographidLand setting
®Ridge ❑Slope OValley ❑Flat
(:hack appropriate box)
Latitude/longitude of well location
County CHEROKEE
I I. DISINFECTION: Type_ Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 142 Et. 6 1/4" .188 STEEL
From To Ft.
Prom_ To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter SIot Size Material
From To Ft. in. in.From To Ft. in. in.
I5. SAND/GRAVEL PACK:
Depth Size Material
Frorn__115_ To 205 Ft. 78M STONE
From To Ft.
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 142' RED CLAY 8 GRAVEL
142' TO 205' MARBLE & SLATE
BLUE SLATE
W
LOCATION SKETCH
Show direction and distance in miles from atTeast
two State Roads or County Roads. Include th jroa4.
numbers and common road names.
U•1
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE. WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TH ' COPY OF TIRS RECO HAS BEEN PROVIDED TO THE WELL OWNER
7-/7 cif
__________
SIGTUREO`r RSON .ONS" LING THE WELL
DATE
r
Submit the original to the Division of Water Quality, Groundwater S!ectIon, [636 Mail Senice Center
-4 Raleigh,
h7/2i)OI
27699-1636 Phone No. [phone], within 30 days. ! ` I
U L

277478
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION N 3295
WELL CONTRACTOR (INDIVIDUAL) NAME (Pont) LARRY F. JON
WELL. CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP CO., INC.
ASSOCIATED WO PERMIT,/
STATE WELL CONSTRUCTION PERMIT,/ A(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential Ea MunicipaVPublic 0 Industrial O Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
PRONE X 82( 8) 1337-8008
2. WELL LOCATION:
Nearest Town: MURPHY
ROCKRIDGE RD
County CHEROKEE
(Stree( Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: KEN GALLOWAY
Address 33 RAVEN LANE
(Street or Route No.)
MURPHYJ_ NC 28906
City or Town State
( 828 )- 837-6083
Ares rode- Phone number
4. DATE DRILLED 08-01-2003
5. TOTAL DEPTH: 405'
6, DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 200 __ FT.
(Use "+" if Above Top of Car imp
8. TOP OF CASING IS 1 FT. Above Land Surface'
"Tap nr rating terminated aUor below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gprn): 1/2 METHOD OF TEST AIR
10. WATER ZONES (depth):
Zip Code
Topographic/Land setting
LORidge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degre shnimilesheconds)
Latitude/longitude source:OGPSOTopographic map
(cheek box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 33' RED CLAY
33T050' SANDSTONE
50TO 405' BLUE SLATE
I i DISINFECTION: Type CHLORINE
Amount 100 PPM
12. CASINO: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 50 Et. 6 1/8" SDR 21 PVC
Eton) To FL
From To Ft.
13. ( ;ROUT: Depth Material Method
Pram 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Et in. in. _ From To Ft. in. in.
15. SAND/GRAVEL, PACK:
Depth Size Material
From To Ft.
From -- To Et.
O
C
LOCATION SKETCH —
Show direction and distance in miles from atljast 'i _-
two Slate Roads or County Roads. Include thCroad.
numbers and common road names. iV 0:_
16. REMARKS: _-- ---- — ---- ---
1 IX) HEREBY OATH' Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WHIT 15A NCAC 2C, WELL
CDNSTRUCILON STANDARDS, AND HAT A COPY OF DI RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
SIGNA `IrEOF PERS ONSrT.RE1iKTINS'r_LIE_WELL—_ _DATE
Snhmit the original to the Division of Water Quality, GrougtJWatie,1' Se tittR L.43k Zixii Stricsi teen r' Raleigh,
C
27699-1636 Phone Na. [phone], within 30 days. (h �I I i
I1

WELL CONS'I`ItUCTION RI:COI(1)
L:,,,1h 1 ;:n.lilpl - 14•HiTnucnt or F.nvitonnicnt and Natural Resources
-
Iliv ism!' of WalcQ r huffily - Groundwater Section1
\,I11 ('('XI VA( I OODI INIIIVInUA1.)NANME (Print)_._—s� a`;4• ft%)' `0'I J_.. -____— CE.RTIFICA'IIONM_-s 7)-
\,III 1(N 114\f I (IR (11\IP,\N1' NAME
.I tim (AIfi CJ .1. YLt PHONE N (3361 [( -Sr.(Mlb
51 \ I I. \\1 I I. ( ()NCI WWI ION rERMIltl .1_.... ASSUCIAI F-❑ WO t'ERNItIN
1 iI itl irablrl (if applit:,blc)
�rFsr.11�l�re�
I I I;Sl1 (1.'Ir; (I. Applicable Box) Residential 0 Municipal II Industrial 0 Agricullural 0
'.I )1111n1 n-g Li liC11,v111V ❑ Ilcat Pump Water Injrrlion IT Oilier CI IIOIher, List Use N { 7 S
'V Ill L1 11',AI
.1 I I men /71061;1 1 Cuunly el
/S -»Z
r i ,,.• tirmikr,,' .'11'' 1 1p, Sllh,ll\l:11p,, lot No., Zip rod
I(.11r-t n, Route No.)
1.4 / rl2E
( a, •'1 1 7 it' - lip Crle-----
)-_(-PY✓Gf/S.—
n Or PhonyI I,.I•<,
1) \ rI litll 1.1 u_ ?..-_3_v __--
5 I4)1AI. PIPII _
t, In WIWI. RI-I`I ACE EXISTING WELL? YIiS l_1 NO ❑
? c; Al I( WAIF I;II;VF:LBelow Top cif Casing; _L_4l)',-_Fr.
(1 Ise'.+•• it Above lop ur('r
I1)1'111 I'.ASINII IS __IFT Above Land Surlhl:c"
• toy of r:oho) Irnniunlyd rotor blow land eurtnre require.)).
nlanrr hi Ill OP In Pit r \'llh 15,\ N(AC 2(. MI Ir
Icpn16 77A. . METI101) OF fES1 r(( /)-
--
In 1I1' /OPII S olrpthl: 4/6 (/ �q 'Pra ...-- --_-
•
1I IlIS!N!i•( III ))d Irpr- _—.-- AIWW)1
A.`11rRl Walllbickms
I)rl'd1 Diancicr or lVcigl tl1 P, (.vdial
l 1•nn.'.... I" 3'(--1-1-_i¢.rkf--- 1r- .Y'!'r='--
11nn In _--_Ft._--------
1 run. _..
1.1 111'OI I- Urplh 1\41tcrial NL:du,d
vimI'„
I.1 I'I I-rJ I)ialncicr Slut Siac 'I,IL•1i;d
l HIM 1, - IC.---__- in.
I1 1111 11, FI._-__ _-in.
• \rll) (11?:\\'1''! I'.\YK'.
I).1n1, Si,r
11!m1 I=• -- _1'I
I I„111 I . 1'1
16 PI L1 AI'LS.
11.
in
277477
Topographic/Land setting
I II'.idrc. ❑Slope IJVallcy ❑FIaI
Ichrr) nppwptialc final
1 unit)de(longilu(IC of well location
t,IrpcCUmimnet/\ecoodq
I.alilu•I -.(,,chide snurcc:Ll(IPSI]Topographic map
tdleck box)
DRILLING LO(Q
Fou Description
/'J 74- Vro-^-•C
1111'III
lb
Jr„
W
.3ir)(O'F 17.1-5,2e
I OCATION S_LETCII —
Sboa• di! c((ion and distance in miles fronrat
Iwo Sl-Inc (Road; or County (toads. Inch l�eigie
IllllllbCl ; I1,111 common road names.
1111 III RIMY (I'P. I II \ rIlAT I I-11S WELL WAS CONSTRLIC I FI) IN ACCORDAN(P. Veil II I5A NCAC 2C, NVELI.
(l)':; I'.II'IIONSIAV1),AltIS,ANT)IIIATACOPYOF1HISRILORDHASHI'IgiPRl.)VIDLD1OfllliWELLOWNER
ill(.!(,
SI( jAt1.1121iOF ERSONCONS 1RJ1:TIM(1 tl IV,1_11 — DAlt
'inbuilt flu r ti itginai 111 the Dirisiou Of \b'ater Quality, lit nundulq(ellSection, 1616 NIail Sr rcirc er!dpri- Raleigh, NC
rIlln,r N'n. t"11) 711.3221, within 30 days, ItEV. 07R0OI

RECEIVED
N.C. Dept. of ENR
SEP 1 0 2003 11'3LL U./INSTRUCTION IUslAi1W
277020
Winston-Salem Ipinlil Unom!d W'nlcr Section
IJo11R49 �h0HIEb'I'nl laical of Environment oral [blur Ilenum ccs - Ulvlslun ul \v n;e Y -
wE.LLC(rN I RACIOlt (INI111IIJUAh) NAP.{F.hPrl„I) ilr'v1P5 ,,`"` \'L-I' Sip CF.flh A!r,ri11'Z�q�
lIONE
wEll, CNN I IIACI (11t CUMrANY NAME 71:1 ; o0 dC, `tnp
t ASSUCIA I VD WI) PE:101I111
SIAIF, I(ELLC(RIgllrll('I ION rF.lUlllN ---- itnrticnblc
lir npplicnhlc
I. W II.I, USI? (Check Applicnlrle 110i3: Ilc^.idcnlinl 1.1 MvuicIlrnl/I'uhlic U Iudusllinl I I Agricultural U
Monitor hip U Recovery U Ilen1 Pinup \Vntcl Injection LI Ulllcr U If Other, List Unc
2. \1'RI.I. LOLA-I ION: 'I 'trugln udl.nnd eellinl!
Nearest l own: rnsf
C,o'I'llyc iesc*p_ Lilg.,lpe LlVnllcy UIInt
•
O\A.� �2-L1 —•a�ie,onrrrn
(surer Howie, Nmnlrzr, G,..._nv. Subdivi+Inn. till No., Zip(.tr) Lnlhuddlof well location
3 c; Cr I ; 51 k/ 4 f 1 2 i) I
1. IL 19f- `
_i_—AdnICsg iA7 .": 5#AYr_ Lnlilu al^ugilude sourceLl(1SCI I apnglnplic o: ,p
f_Snerpor"retie Nn)3356 5 Krill IchccI.1..;
1Cork Rlmn ),ltill LU_l1
City o, Io'_ Stine fFormation Ucscnipliun
___— _ ' (C5 `
Aire rrvlr. I'Imnr nnniba
. 1. DATIE 0RII.LIIU 51n
5. 10 h A L Ilia' 1 1 I:,�. 5_ _-- -_ --. ----
6 UUIES WE.LI, Ill'.I'LACII EMISIINO WIEI.13 YES U NO I'I--
7. S 1Al IC WA FElt LEVEL Relay/ Top of Casing' ._ QJ-__--I' 1 •
(ore"r• If Above lop nr Cmb,E)
A. 1 OI' OF CASINO IS ___I__ ___ I'I. Above I.mu1 Sullhce
' Irp rt rad,' f Ir„nlnotrl •Ilrr hrlon lend rv,l.re re!p,lrrr
8.
r1Iluge h, nun, dome nllh IlA NUM' 7(7.n1111.
Q. YIP] LU(grit _tDb ____ NW I11UUUE1ESLite —
1 U. WA 1 Ell ZONES (Irl,lb): __
il. [trim fpcIION: "I)Ire 011p�t_
4.1
12. CASINO: Uimncicr
17rplh
Rant L . 1 0 — 1.1. aS-
f I nil l n— FL_
train_ 1n_..— rt.
--- _--
11. Gum': Depth
IA Ictinl Method
tLTo 1 It.
H. SCI,rI:II! Perth Neuritic! Slot Sire Mnlclinl
t., II in. in.
Ilom — . — -. ---
i o I l II!. in.
floor-- -- — -- —
15. SANVIUI(AVII. PACK: ptr,Irr!nl
UrpIlr Sire
nom to IL__ —__
From__ to_It. _
16. ItEMAIl1:S'
Amount _ i
Wall'I hickncse
or \VrlghVRt. Mnlclinl
_SUM - 'C —
1 V:AVON SKEJ
Slow direction nud (lielnncc hl miler From nl Icnct
Iwo Slnle Monde or Courtly Ronde. Include the I
u inhere nud common rand tunnel.
1 IrU I IERFIIY CEI(111Y MAT 1111S \\'I'.
CONS I I(UCI ION S IANDARUS, AtJI) '11
SIuNA1
Sulndl the or 'Rhin! In the UIrHon of
17690-1616 I'houe No. (919) 711J221, with
' 14111\ 1 Niel:
01'Y 0E'11118 IlECO I
_ - SEP _ 1 5 2093
IU! U' I'IIIISUN MIS I ItUUI It
YnlrA EWIRek6�F�I St cite
cn
.l
IlUR WI11I I 5A IICAC 237, WELI.
EN I'IIUVIDED 10111E WELL OWNER
WELL 12/VIE
, 1636 Mali Service Center - Ilnlelgll, NC
UW-I REV. U1/2001
)

WELL QONTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) FReNZ P. Yi CTOR CERTIBICATION 43175
WELL CONTRACTORCOMPANY NAME F}(tRs WELL ORit.LNG PHONE e 14 )-MT-Z/06
STATE WELL CONSTRUCTION ?EMU ASSOCIATED WQ PERMrTY
una (ifappllceblo) Qf appllcablei es
280110
1. WELL USE (Check Applicable Box): Residential tMunlcipav?ublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery Q Heat Pump Water Irliectton ❑ Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: MuRPtlY CountyCP(62ot<ea
p')ez1n1•15 CREEK Ron
(so-ret Name, Numbers, Community, Subdivision, Cat No., Zip Code)
3. OWNER:
Address
4, A. L6bPoRD
003ox II
(Street or Route No.)
MURPRY NC- 289063
,p� �City or Towa Stele Zip Code
M.)- R37- 72941
Area code. Phan number,
4. DATE DRILLED 9- 29 - 0 3
5. TOTAL DEPTH' A 4 C
6. DOES WELL REPLACE EXISTING WELL? YES ®' NO ❑
7. STATICWATER LEVEL Below Top of Casing n
(U S. TOP OF CASINO IS 2 FT Above Land Surface'
'Top of casino terminated OW below land terrace metro;
varIseet In accordaa co wish 15A NCAC 20.011 & :
9. YIELD (gpm): f �. METHOD OF TEST G 1 R
10. WATER ZONES (depth):?2O' -to GPM 230-2 6vm
11. DISINFECTION: Type
12, CASING:
Depth
Fro /m 59 To 33
From_3 _To 42-
From To
13. GROUT: Depth
From 2.0 To O
From To_
14. SCREEN: Depth
From, To
Frorn To
15. SAND/GRAVEL PACK:
Depth
From To
From To
16. REMARKS:
14ril Amount -//) oz
Wall Thickness
Ft (p 'meter or Weight/Ft,�Criel
18 Ft 6Vq Pvc
Ft,
Material
Ft. CEntrNr
Ft
Method
GRaaYITV
Diameter Slot Site Material
Ft in. in.
Ft.y.p___In, in.
Material
Ft.
Ft.
��sopo�Topographic/L.and setting
P1Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitu4e/longitdde of well location
/C/35°oo.ggt'; Wof4ao3.us? •
(degroahninuwsheccads)
Latitude/longitude soriice:OGPSOTopographio-map
(check -box)
DBPTI} DRILLING LOG
From To Formation Description
) Top Sot
1 - 77
7-7 - 89
g9 - / 27
/27- /45.
lei 5-24s
re,a CC 2 v
rC�oRRY wEeniemern Rooic
N Row nl WEBrr/eReR Roc.c
G2QY Stara
/tZ 11<Q22.
W �
0
LOCATION SKET_CFI 0'
Show direction and distance in miles at
two State Roads or County Roads, Inc u e thp,ri3gd
numbers and common road names.
I D0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND�THAT A COPY OP THIS RECORD HAS BEEN PROVIDED TO T-D2 WELT. OIVNFR
4 I ATURE 0P PEPERSONCONSTRUCTIN0 THE WELL AT ® J
Submit the original to the Division of Water Quality, Groundwater Seetion,1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days, OW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Napral Resources - Division of Water Quality - Groundwater Section � e-�LON# •`fo15
'
WELL CONTRACTOR (INDIVIDOAL)NAME (Print) Yet/,Y— PRONE N CERTIFICATI21�N
//e,- watt Orl l
ASSOCIATED WQ PERMIT#
(if applicable)
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT#
if applicable)
1. WELLUSE (Check Applicable Box): Residential E]/Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ID Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
DRidge (lope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
• (degrees/minutes/seconds)
Latitude/longitude source:❑GPSC1Topographic limp
(check box)
REM to s.L.t"tr,G
From To
280134
2. WELL LOCATION:
Nearest Town:
-so d cwrt !/�V
(Street Name, Numbers, Community, Subdivisira, Lot No., Zip Code)
3. OWNER:_ ��
Address
1y Starhe-f
(Street or Route No.) 2gaDlO
m
City or Town State
County
Area code- Phone number
4. DATE DRILLED_]
5. TOTAL DEPTH: 3..t d '
6. DOES WELL REPLACE EXISTING WELL? YES
O NO 8--
7. STATIC WATER LEVEL Belowt se"+Top of Casing:
AbovegTop of Casing)
OF CAGING IS Fr. Above Land Surfaces
8. TO!^ __ a
*Top of casing termlo.ted at/or bavn :-..a rugs" renutres
variance In accordance with ISA NCAC 2C AI la.
9. YIELD (gpm): .--METIIOD OF TEST /2!------
10. WATER ZONES (depth): .70 ��
Zip Code
t�G
Formation Ducrintion
-/S--
11. DISINFECTION: Type
12. CASING:
Depth
0
From To i�
d3
/bv 320
G
I CAT[uly y:F_TCA
/ref Amount �`/_ O _ Show direction and distance in m
s or County Roads. Inctale the retail
two State Road
Wail Thickness numbers and common road names.
Diameter or Weight/Ft. Material
Ft. 4.- 5401 uG
iles I tot-=�-least
From To Ft.
From To Ft.
13. GROUT: Depth Ft.
From To
From To Ft.m
14. SCREEN: Depth Diaeter
From To Ft. in.From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
it aeftat Method
O/�('•rd cvfJ`/Mf
Slot Size Material
in.
in.
c
0
0
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5 4 -03
IGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Ceenter, REVgh, NC
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater
Se Mtion
1-1
WELL CONTRACTOR (INDIVIDUAL) NAME (print) hA PHONE CEoRTlN# (A2�5%=c
iicY t.1oll lliYtijlnA__— -.
WELL CONTRACTOR COMPANY NAME • SSOCIATED WQ PERMIT#
if avplicable�
STATE WELL CONSTRUCTION PERMIT#
(rf a licable) -
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge @Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N�S`13r 0 t~)3' r�3"
(degrees/minutes/seconds) p ra hie
Latitude/longitude ❑GPS❑To og p map
(check box)
DEPTH
tULLr1.121t U i
Formation Dczcripo
ue^priors
280135
2. WELL LOCATION: Count
stTown:A Pt �S1 y
Name, Numbers, Community, Subdtvisica, Lot No., Zip Code)
(Strce
3. OWNER:
Address
(Street or Route No.) ',NA()
$q t
fttr ; IJC_. Zip Code
City or Town State
Area code- Phone number
4. DATE DRILLED °7 i ti D z
5. TOTAL DEPTH: �4_ 6. DOES WELL REPLACE EXISTING WELL? YES El NO a--
7. STATIC WATER LEVEL Below
Use" o if Aboveg
Top of Casing)
8. TOP OF CASING IS _J--
FT. Above Land Surface`
*Top of casing terminated at/or below land surface requires a
variance In accordance with I5A NCAC 2C .0118.
9. YIELD (gpm): 1a METHOD OF TESTt��t� ---
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
Frorn,_12— To—.
From To
From To Ft.
ateri l
13. GROUT: Depth
Frotn Tom Ft.
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK: Size
Depth
From To Ft.
From To Ft.
16 REMARKS:
From To
D lam`
nN SKtt
,G t Amount 15 — Show direction and distance in miles front at least
Wall Thickness two State Roads or County Roads. Inc de`the road -
Diameter or Weight/Ft. Material numbers and co on road names.
7--
Ft.
Method
Slot Size Material
in.
in.
Material
IN ACCORDANCE WITH 15A NCAC 2C, WELL
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenteri RREVgh, C01
276g9-1636 Phone No. [phone], within 30 days.
DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Enviromnent and Natural Resources - Division of Water Quality - Groundwater Section
I� l�• \S�`^ CERTIFICATION M �y�y
WELL CONTRACTOR (INDIVIDUAL) NAME (print )`Z 1( PRONE q (
u t1 a�\'nc
WELL CONTRACTOR COMPANY NAME ASSOCIATED WQ PERMITB
STATE WELL CONSTRUCTION PERMIT/ if a licable
if licable
I. WELL USE (Check Applicable Box): Residential al.—MunicipaUPublic 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery n Heat Pump Water Injection 0 Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ne DValley °Flat
(check appropnsto`^•)
Latitude/longitude of well location
r(�S°n rya t,.1g`/ qC
(degrees/minutes/scconus)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
pI PTH
DCci=�_
From To Formation Description
�f75
2. WELL LOCATION:
Nearest Town:
Nam
,N"-`� ZipCode)
Nam Numbers, Community, Subdivision, Lot No.,
3. OWNER:
Address
City or Town State
County c c€Z .0
(Street or Route No.)
tJC 2BCIb(t
Zip Code
Area code- Phone number
4. DATE DRILLEDer - 14 - nZ
5. TOTAL DEPTH: Zn ---
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO D —
7. STATIC WATER LEVEL Below Top of Casing: ___(QI--FT•
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS l____—
FT. Above Land Surface"
•Top of casing terminated actor below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): ___&—
METIIOD OF TEST 1 --
10. WATER ZONES (depth):
Amount \ h Show direction and distance in miles from at least
11. DISINFECTION: Type Wall Thickness two State Roads or County Roads. Include the road
12. CASING: nl�nbers and common road names.
Depth Diameter or& �t. Ma-
From To_ FL (o � �
From To Ft.
From To Ft.
13. GROUT: Depth
Material 1 Method
Ft _ __ I /_,_- fc sSZCC
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From
To Ftin. in.
15. SAND/GRAVEL PACK: Depth Size Material
From To Ft.
From To Ft.
280136
Cs\
At a
c ell
o
0 to
ca
o `, ,
-11 c m
1 o.c
Crt -n
y0
16. REMARKS:
1 CONS
1lFRE6Y N STAY MAT, AIS WELL n THAT A WAS
ONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
Y OF THIS RECORD HASEEN PROVIDED TO THE WELL OWNER
CONSRUCTION STAND-�.•--
SIGNATURE OF PERSON CONSTRUCTING Tr••IE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Ralciz)": NC
GW-I REV.07I2001
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
VJ._ GroundwCERTIFICater
Section
North Carolina - Department of Environment and Natural Resources `Division of Water Quality Groundwater Seaton
(INDIVIDUAL) NAME (print) \ GZg 83--2qG�
N N
WELL CONTRACTOR( nt t � t \l rt�t 111 - _PLIONE p '0�
WELL CONTRACTOR COMPANY NAME 1\tl e • SSOCIATED WQ PERMIT#
(ifaDPlicable)
STATE WELL CONSTRUCTION PERMIT#
if applicable)
I. WELLUSE (Check Applicable Box): Residential Pr Municipal/Public 0 Industrial 0 Agricultural ID
R
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other 0 If Other, List Use
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) p hiC
Latitude/longitude source:❑GePIS❑ jo ogra p map
(chr yr�lu�(j
DEPTiI DtciLya.
From
Formation iiczcrirtion
� , _ � r
280133
2. WELL LOCATION: ��o/D7rCZ
earestCT
(Street Name, Numb n, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
City or Town
Area code- Phone number
4. DATE DRILLED S
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO /
7. STATIC WATER LEVEL Below (Use
U Top
+o f At oovBe Top of Casing)
I
8. TOP OF CASING IS �� Fr. Above Land Surfaces
Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): � METHOD OF TEST
WATER ZONES (depth): k
10. 1D-C-A1
10N SICEIgh,
? mount / ( Show direction and distance in miles) from at least
11. DISINFECTION: fype� -- Wall Thickness two State Roads or County Roads. I clod o ad
12. CASING: Dieter or W ight/Ft. Material numbers and common road names.
Depth �---
From To� Ft. _ S0 1 p r 0 0
From Tom_ Ft. w -�
Tu Ft to
From Material Method
--t cc'
13. GROUT: Depth V v( r"
To 6 Ft. D r^) N I o c
From t a_
From To Ft.--- — -- -- v mo
14. SCREEN: Depth lliwneter Slot Size Material = �m
From To Ft. in. in.
z.
rri
From W To Ft. in. in. ro in
15. SAND/GRAVEL PACK: COz
Depth Size Material
From To FL
From
To Ft. --
From_____—
To
REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL
L OWNER
r/ t 6
SIGNATURE OF 1'ERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Ceenteri R IVgh, C01
27699-1636 Phone No. [phone], within 30 days.

2. WELL LOCATION: y�
Nearest Town:'^^IA41s Count
1lwtt fnU
(Street Name, Numbers, Community, Subdtvisioa, Lot No., Zip Code)
3. OWNER:
�g1fc i US �r�u Log
�1
Address (Street or Route
1Jl
Mug
City or own State
Area code- Phone nu D
4. DATE DRILLED
5. TOTAL DEPTH: �iE�S
6. DOES WELL REPLACE EXISTING WELL/ BYES NO �
7. STATIC WATER LEVEL Below U op of 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 ■ecordante with IS METHOD OF TEST dI �—
CAC 2C .0118.
9. YIELD (gpm):
10. WATER ZONES (depth):
Amount
11. DISINFECTION: Type Wall Thickness
12. CASING: Diameter orWeight/Ft. Material
Depth S� f
From_____ To 116
ILIgar
From To Ft
From To Ft.
Material i
13. GROUT: Depth t Ft. �
From__ To_
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From_To Ft. in.
15. SAND/GRAVEL PACK: Size Material
Depth
From Tn__. — Ft
From To Ft.
Zip Code
S
Method
Slot Size Material
in.
in.
16 REMARKS:
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater Section
CERTIFICATsIgfia
.rrnINDIVIDUAL) NAME (print) 'v N
WELL CC..---ACPOR(tl ._��•\I:,na PHONE " k��alu�,�bz�>
WELL CONTRACTOR COMPANY i4N•%1:
(l'1 )1p tNr
kS$OCIATED WQ PERMITS �--
STATE WELL CONSTRUCTION PERMITS if iicaL1L"
if licablc
Box): Residential m— Municipal/Public 0 Industrial 0 Agricultural G
1.
280132
WELL USE (Check Applicable ox
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
TopographiCfLand setting
[Midge ['Slope 131-V illey ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds) p ra hiC
Latitude/longitude source:❑GPS❑To og p map
(check box)
Dt�Lr ,*`•a�QQ
orrpatiou Description
From
To
— Sr
1 nnAT10N�K-�H; -
Show direction and distance in mrle$Trorp at least j
two State Roads or County Roads. Ihclude thel md
numbers and common road names.
c
0
GJ
0
n
--1
ON
a
W
N
CO
IN ACCORDANCE WITII 15ANCAC 2C, WELL
I DO HEREBY CERTIFY T)RAT THIS WELL WAS CONSTRUCTED
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TTIE WELL OWNER
3
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality, Groundwater Sectlon,1636 Mail Service Center -Raleigh,NC
Raleigh,
27699-1636 Phone No. [phone], within 30 days. GWrI REV.07/2001
DATE

WELL CONSTRUCTION RECORD
Division of Water Quality - Groundwater Section
rc,2Yl iS C7
PHONE # tp�c.---
SSOCIATED WQ PERMITM
if aDPlinable)
North Carolina - Department of Environment
280130
and Natural Resources - C �� CERTIFICATION #'Zy
Tint In nn p 5 .l7 ------ 4
WELL CONTMCCOR(INDIVIDUAL)NAME (print) ^O � \II � 3
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT/
if a licablc
I. WELL USE (Check Applicable Box): Residential 0----lolunicipal/Pubiic 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
❑Ridge Ifslope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
%'ior 51
(degrees/minutes/seconds) P ra )tic nv1
Latitude/longitude source:❑GP❑,o °B P p
(check
11- yi�r�L Q
tiou Dccrintion
2. WELL LOCATION:
Nearest Town
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
1�1�tLAW\ State Zip Code
City or Town
Area code- Pbone number3
4. DATE DRILLED
5. TOTAL DEPTH: /(2
6. DOES WELL REPLACE EXISTING WELL? YES El NO 0
7. STATIC WATER LEVEL Below Top(Use " of AboCasing:
Above Top of Casing)
8. TOP OF CASING IS
FT. Above Land Surface*
*Top of using terminated aVor below land surface requires
q s
vIELD _ncewith ISMETHODOFTEST/4/
C 2C .0118.
9. YIELD (gpm): ��-
10. WATER ZONES (depth):
County C \iNecm e
11. DISINFECTION: Type
12. CASING:
Depth
Frorn __. To
From _To Ft.,
From To Ft.
13. GROUT: Depth
From rr To
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
Amount 15
Wall Thickness
Diameter or�Wcig�ltt/Ft. Material
Ft.�_
M torial Method
Ft.10,11 n�PS rLe
Ft.
Diameter Slot Size Material
Ft. in. in.
Ftin. in.
Size
Ft._
Material
DEPTH
From To
Forma
rQCAF��__IONSK tOtt
Show direction and distance in miles from at least
two State Roads or County Roads'. IncTud the rod
numbers and common road narrs
16. REMARKS: WELL
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITS' 15A NCAC 2C,
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TILE WELL OWNER
( SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
, NC
Submit the original to the Division of Water Quality, Groundwater Section, 1636Ivta11 Service Center -Raleigh,
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. h
(c

WELL CONSTRUCTION RECORD
279526
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION # 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I8 Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MARBLE
PUETT COVE
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, tat No., Zip Code)
3, OWNER: JOSEPH JOLLEY
Address P.O. BOX 1776
(Street or Route No.)
GOLDENROD, FL
32733
City or Town State
( 407 )_ 679-7995
Area code- Phone number
4. DATE DRILLED 09-23-2003
5. TOTAL DEPTH: 405'
Zip Code
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO @
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "P' 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 I5A NCAC 2C .0118.
9. YIELD (gran): 2 3/4 METHOD OF TEST AIR
10. WATER ZONES (depth): 200'
II. DISINFECTION: Type CHLORINE
Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 152 Ft, 61/8" SDR21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 152 Fl. CEMENT PUMPED
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15
SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Material
Topographic/Land setting
@Ridge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitudc of well location
(degrces/minutes/seconds)
Latitude/longitude source:DGPSOTopographic map
(check box)
DEPTH DRILLING LO _
From To Fomation Description-
0' TO 60' SANDSTONE
60' TO 100' RED CLAY
100' TO 120' BROWN DIRT
120' TO 152' SLATE
152' TO 405' SLATE
O
0
r
0
rri
LOCATION SKETCH 3
Show direction and distance in miles from at lea}V
two State Roads or County Roads. Include the roil
numbers and common road names. r,D
VAS k . L—
16. REMARKS:
11)O IIEREBY CERTIFY THAT T1115 WELL WAS CONSTRUCTED IN ACCORDANCE WIIII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATA COPY OF THIS 'CORD IIAS BEEN PROVIDED TO' 1IE WELL OWNER
SIGNATURE Ur PERStIN SIRUCIING 'lIIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Senice Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
ern
o<

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION q 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
VANDORA SUITS RD- BURCH HILLS
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Tot No., Zip Code)
3. OWNER: PETE BURCH
Address 150 VERONICA LN
(Street or Route No.)
MURPHY, NC 28906
City or Town State
( 828 )_ 837-0627
Area code- Phone number
4. DATE DRILLED 09-15-2003
Zip Code
5. TOTAL DEPTH: 70T
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO KI
7. STATIC WATER LEVEL Below Top of Casing: 63 ET.
(Use"F" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated atlor below land surface requires a
variance in accordance with ISA NCAC 2C .011R.
9. YIELD (gpm): 2 METHOD OF TEST AIR
10. WATER ZONES (depth):
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 95
From To
From To
13. GROUT: Depth
From 0 To 20
From To
14. SCREEN: Depth
From To
Amount 100 RPM
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 1/4" SDR 27a PVC
Ft.
Ft.
Material
Ft. CEMENT
Ft.
Diameter
Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Topographic/Land setting
IiIRidge ['Slope ❑Valley ❑Plat
(check appropriate box)
Latitude/longitude of well location
3524.097N/8347.904W
(derecs/minutes/scconds)
Latitude/longitude source:EIGPSOTopographic map
(check box)
DEPTH DRILLING LCG
279524
From To Formation Description
0' TO 95' PRE-EXISTING CASING
95'TO407' GRANITE
WELL WAS 40T DRILLED DEEPER TO 707'
407' TO 707' GRANITE
c
C3
m
V
Method
GRAVITY
Slot Size Material
in.
in.
Material
n
0Lam_
F
-m
to Km
>0
LOCATION SKETCH 3 xm
Show direction and distance in miles from alkisast enz
two Stale Roads or County Roads. Include t_roariE—
numbers and common road names. an 5
z
16. REMARKS:
11)0 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIT!! I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS ECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
•
tSIGNA
E OF PERSOFfQONSTRUCTING TILE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION IS 3295
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE n [phone]
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WO PERMITS/
(if applicable) (if applicable)
279523
1. WELL USE (Check Applicable Box): Residential 1 Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 if Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
VALLEY RIVER MTN. - DAYLILY DR
County CHEROKEE
(Street Name. Numbers, Community, Subdivision, lot No., Zip Code)
3. OWNER: LEWIN WEST
Address 963 UPPER PEACHTREE RD
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Code
( 828 )- 837-7820
Area code- Phone number
4. DATE DRILLED 08-20-2003
5. TOTAL DEPTH: 807'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 123
7. STATIC WATER LEVEL Below Top of Casing: 43 FT.
(Use "1-" if Above Top of Casing)
8. TOP OF CASING IS 1 ET. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1/2 METHOD OF TEST AIR
10. WATER ZONES (depth):
I I. DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 34 Pt. 6 1/8"
From To Et.
From To Ft.
13. GROUT:
From 0
Depth Material
To 20 FL CEMENT
From To Ft.
Atnount 100 PPM
Wall Thickness
or Weight/Ft.
SDR 21
Material
PVC
Method
GRAVITY
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To FI.
16. REMARKS:
m.
Size Material
Topographic/Land setting
RIRidge ❑Slope ❑Valley OF at
(check appmpriatc box)
Latitude/longitude of well location
((tegrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographie heap
(check box)
DEPTH DRILLIN LOG
From To Formation De --
0' TO 20' RED CLAY
20' TO 34' RED CLAY & SLATE
34' TO 807' SLATE
c
SD m
LOCATION SKETCH-13 e
Show direction and distance in miles from at tist
two State Roads or County Roads. Include for ad M
numbers and common road names. c n;
L.^-\)
L ILcJ
LQI j
I DO IIEREBY CERTIFY TIIAT TIILS WELL WAS CONSTRUCTED IN ACCORDANCE WITI 115A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THATCOPY OF THIS RE RD HAS BEEN PROVIDED TO TIIE WELL OWNER
9 LU2 3
SIGNATURE Ol=/PERSON COP STRUNG TIIF. WELL DATE
CII
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mali Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- 1 REV. 07/2001
0

WELL CONSTRUCTION RECORD
279522
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION if 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE (Check Applicable Box)' Residential El Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
VALLEY RIVER MTN. - DAYLILY DR
(Street Name, Numbers. Community, Subdivision, lot No., Zip Code)
3. OWNER: LEWIN WEST
Address 963 UPPER PEACHTREE RD
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Code
( 828 )- 837-7820
Area code- Phone number
4. DATE DRILLED 08-15-2003
5. TOTAL DEPTH: 305'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 252 ET.
(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 ISA NCAC 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST AIR
10. WATER ZONES (depth):
Topographic/Land setting I c
KiRidge ❑Slope ❑Valley ❑Flat .!
(check appropriate box) •
Latitude/longitude of well locations
(degrees/minutes/seconds)
Latitude/longitude source:DGPS0Topogrhphie%map
(check box)
DEPTH DRILLING L(19
From To Formation Deseription - -`
0' TO 20' RED CLAY
20' TO 58' SANDSTONE & GRANITE
58' TO 305' GRANITE
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 58 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft, CEMENT
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
61/8" SDR 21 PVC
From To
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
Ft.
Method
GRAVITY
Slot Size Material
in.
in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
c
y
Fsa—cit
❑an
LOCATION SKETCH
Show direction and distance in miles from atlitIst a�
two State Roads or County Roads. Include thpspoad �t
nutbcrs and common road names. c- c>
lD , G
�114-i�'_—Ct�7�Ln1t(T L/�
"D cm
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT AI OPY OF T),I\SRECOHAS BEEN PROVIDE]) TO THE WELL OWNER
SIGN UREO�
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001
12Sr;'�.
CTING TIIE WELL DATE

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION # 3295
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
279520
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential ka Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
LIBERTY CIRCLE
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: C. J. PAPAKRASAS
Address 5639 EXECUTIVE DR
(Street or Route No.)
NEWPORT RICHEY FL 34652
City or Town State
( 727 )_ 846-9126
Area code- Phone number
4. DATE DRILLED 09-12-2003
Zip Code
5. TOTAL DEPTH: 225'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 131
7. STATIC WATER LEVEL Below Top of Casing: 80 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of easing terminated atior below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST AIR
10. WATER ZONES (depth): 190'
11. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 80 Ft. 6 1/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
Topographic/Land setting - -
®Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
3507.242N/8416.557W
(degrees/minutes/seconds) Latitude/longitude source:OGPSOTopographieihap
(check box)
DEPTH DRILLING LOG
From To Formation Descpptibn
0' TO 40' RED CLAY
40' TO 60' SAND
60' TO 80' GRANITE
80' TO 225' GRANITE
0
w
C
n
art ?m
T
u
m
LOCATION SKETCH ifa r ri
Show direction and distance in miles from aj4iast y�
two State Roads or County Roads. Include tjigroatS�' o
numbers and common road names. IV m
sea
ros G
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A PY OF THJ RECO HAS BEEN PROVIDED TO THE WELL OWNER
peg-- / —03
SIGNATURE OF P,LLSON CONS'P*OCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279519
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION q 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # f828) 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT,/
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
WEHUTTY RD
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Int No., Zip Code)
3. OWNER: JASON HART
Address 1110 RADFORD RD
(Street or Route No.)
MURPHY, NC
City or Town State
( 828 )- 644-0526
28906
Zip Code
Arca code- Phone number
4. DATE DRILLED 09-11-03
5. TOTAL DEPTH: 205'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 40 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 2C .0118.
9. YIELD (gpm): 30 METHOD OF TEST AIR
10. WATER ZONES (depth): 130'
I . DISINFECTION: Type CHLORINE
12. CASING:
Depth Diameter
From 0 To 96 Ft. 61/8'
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
Method
GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. '
Topographic/Land setting
❑Ridge ®Slope 0Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:I3GPS0Topographic-n1a0
(check box)
DEPTH DRILLING L G
From To Formation Descri lion
0' TO 30' RED CLAY
30' TO 50' BROWN DIRT
50' TO 80' RED CLAY
80' TO 96' GRANITE
96' TO 205' GRANITE
r:
O
c>
rn o
LOCATION SKETCH c n
Show direction and distance in miles from mast
two State Roads or County Roads. Include the oat)?,F
numbers and common road names.
�rfl
,,
16. REMARKS:
1 DO (HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE W Illl I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TFIATA COPY OF THIS 12E RD 11AS BEEN PROVIDED TO "HIE WELL OWNER
o3
SIGNA-IURE OYii'ERSON CQ 5TRUCIING TIIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

279612
WELL g4NST$UCr1ON RECORD
North Carolina - Department of Environment and Natural Resources -Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) ���NZ r . 1l /G% 2 CERTIFIC7AT/IIO.J N Y 3 / 7
WELL CONTRACTOR COMPANY NAME 87612S Lu ELL O/2/f_L/f , PHONE it7 ��T 7ys'z/�
STATE WELL CONSTRUCTION PERMIT' ASSOCIATE)) WQ PERMFTO
ifay liable . If a•licabi
I. WELL USE (Check Applicable Box): Residential t1MunkipaVPublic 0 Industrial 0 Agricultural O
Monitoring 0 Recovery Q Heat Pump Water Injection 0 Other 0 1f Other, List Use
2. WELL LOCATION:
Nearest Town:/l/U/Ohl5/ CountyC/idtokF�
AA/eEL/co MTN. Se77Le 6'v7
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Coda)
3.OWNER: G1R&D Le &
Address /4 / .C/7LE CRIC
(5 tract ar Routc No.)
CDOSS//-r6
3 0 5/3
City or Town SW° Zip Code
(7OG)- 238- 170/
Area code- ?hoot auntbcr
4. DATE DRILLED_ 9'/8 — 03
5. TOTAL DEPTH: 41 (0
Topographic/Land setting
QRidge CISlope OValley Mist
(check appropriate box)
Latitude/longitdde of well location
/V35-02.00n woa4'/R.5'7/
(dathninutes/aecoodr)
Latitude/longitude sotirce:PdPSOTopographic.map
(cbeck box)
DRILLING LOG
R6Forma
q tion CCYDeyscription
P/Nk r Le
8/?ow,u S nO
/?t o. w wesnSe1 Abctc
L8zk ezav Irian Roar
<Aar razes- roc?' 720 c1
LTGRa/ //2/W Rai CA.
L7 5r2c9Y USoa'7-,tea 0(;
27-6.2av ffeej ysz/t
%DC2'h GRay'So/92oc✓-
Denc Gaza 9//'a/zp l4 ,c tc
- LOCATION SKETCH
how direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road name, c
,%/'RK GRc Sbf Rock
L)eel< GRN/lefg,V20cfc
—0 c
N.1 U:It:
is •=rn
rn
3 cn
O rn z1,1
DEPTH
From To
0 70
/0 a
ptb
33 76
6. DOES WELL REPLACE EXISTING WPT.,1 YES 0 NO 7z 92
7, STATIC WATER LEVEL Below Top of Casing; .30 FT qio /35-
(Uao'+" If Abovr Top of Cuing) ./5Q /5-Z
8. TOP OF CASING IS a FT Above Lend Surface' 15:2_ •205 'Top ur cuing terminatad °Fur below laad surfs.. 1tgoRu a
varier.. In sceordit' po wltt 1$ANCAC 20,e11&:
9. YIELD (am): / z- METHOD OF TEST .A 1 IC
10. WATER ZONES (depth): 070 S /2 Gpwt
11. DISINFECTION: Type
12, CASING: Wall Thickness
Depth D r or Weigh
t/Ft.Mete 'al
From? 2 To 8)/ Ft, 61/9 SDI?/ tJ'
From To Ft.
From To Ft
13. GROUT': Depth Material Method
From 0 TO 2 D Ft. C'-&w ijr aeskfiPil
From To Ft.
14. SCREEN: Depth . Diameter Slot Sit .; Material
From. To Ft, _,in, in.
From To Ft.a..,jn in
15. SAND/GRAVEL PACK:
Depth: Size .; Material
From To Pt,
From To Ft.
16. REMARKS:
/Pre/ Amount -/ /6
dos 442A
a /.z 470
aao ass
e79S -3o 5
30s-96s
n
-y
C G
z
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL I I
CONSTRUCTION ST ARDS, AND T A COPY 0 ram RECORD HAS BEEN PROVIDED TO THE WELL OWNER
o. , ,/ /q a 3
C./SIGNATURE OP PERSON CONSTRUCTJNO THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days, GW-1 REV, 07/2001

WELL CONSTRUCTION RECORD 279611
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) FR3N 2 P. V/073R CERTIFICATION e3 /
TO7S
WELL CONTRACTOR COMPANY NAME BYRR etv ai D jz I LL I Kt PHONE 1 W6) 7g S-i/66
STATE WELL CONSTRUCTION PERMIT# ASSOCIATEI) WQ PERMITi
wantai(ifapplicablC)_ - _- (Iftpylicablel
1. WELL USE (Check Applicable Box): Residential L"!: MunicipaLPublic 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery O Heat Pump Water Injection O Other 0 if Other, List Use
2. WELL LOCATION:
NearestTOWB: Mu2PeV County CN.62owge
14Naettco ,4t'.6-E77LEIg .,i
(Seat N.nu, Numbers, Community, Sabdiviaion, Lot No., Zip Code)
3, OWNER: G6R.2lfD L0N6
Address /57 4/77L& c.Qk.acts]Nc
(Strom or Route No.)
13Lu6 R DQC C,a,
City or Town State
?O» 38 - 9701
Aron code- Phone number
4. DATE DRILLED 9- / 7 - 63
5. TOTAL DEPTH. 385
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO g 7o 223-
7. STATIC WATER LEVEL Below Top of Casing; 2(2 FT 4ag
(Uee'4"Ir Above Top&Cuins) .— 3 .
8. TOP OF CASING IS a FT Above Land Surfaces
3osi
Zip Code
'Tap of coins terminated .t/ur below land .udaoe regains i
vart.net In accordance with 1SANCAC 2C.011&; '
9. YIELD (gpm): 2 P METHOp OF TST
10. WATER ZONES (depth): A30-a6Pen 37.5-20&Pe/
11. DISINFECTION: Type N'rF{ Amount - /2 oz
12, CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From±2 _To 72 Ft. to'I/S .b/ {ovc
From _To Ft.
From To!
13. GROUP: Depth
Frorr O To 20
Ft
Material Method
Ft.0 1G2,T Gieevfr?
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To Ft.s-,jn in
15. SAND/GRAVEL PACK:
Depth. Size Material
From To Pt.
From To Ft.
Latitude/longitude
From To
0 /2
Topogdphic/Larld setting
❑Ridge [ ope OValley ❑Flat
i (check appropriate box)
Latitude/longitdde of well location ,
N. 35*ov. an wosq /z 9s3
(deatoniniautes/ es)
souice:DOPS OTopograph io-map
(theck boz)
DRILLING LOG
Formation Description
RED CLaV
/ :
,36 4/5
qS 70
7eN twer,162.eo Rode
BROW/4 1.0etnieagetp Rock
GRaa•e_err4ditetterc
ReleD AT.6R2v Rorer
-%-T Daek C2L•)P L2e4L�
betaa L7:CREL9 +2ec.c,
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Includelie road
numbers and common road names. o c,
w
cis
m c
'D �'rn
CM oc
CM Qni
3 zn
nz
O rn
0
CD o
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL I
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER.
1
4r A. ae ;4. ?- /7- 03
SIGNATLI ' OF PERSON CONSTRUCTING T/3E WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center-Rale'gh,NC
27699-1636 Phone No. [phone], within 30 days, GW-1 REV 07/_2001

WEJ,LSO?jSTRUCTION RECORD
North Carolina • Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prtnt) Nee—AIZ P Yl6704 ANCERTWI-CAAtT5
/ION#3/7
WELL CONTRACTOR COMPANY NAME sVe-RS (pea_ DQ(Lcf NGL PHONE t 76) 7I5 o2/Ce
STATE WELL CONSTRUCTION PERMIT# ASSQCIATEb WQ PERMS
ifaoolice/ale ) (if tpplinable)•
1 WELL USE (Check Applicable Sox): Residential l'Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring 0 Recovery CI Heat Pump Water Injection C. Other ❑ If Other, List Use
2. WELLLOCATIIOgN:
Nearest Town:/fl02 Al-E y , CountycY-SQok�
ANC-,GC/Co /3nW. 5 1ass+e v7
(street Name, Numbers, Community, Subdivision, Lot No., 21p Code)
3. OWNER: 6 EPV-JJ 1.otJs
Address /57 /.ITT/G- C Fc C2a5SY,W.
(Strati or Route No.)
DLue RIpce G6- 30573
City er Tow] State Zip Code
e_)- 832 --4i7o
Area code. Phone nutnbcr
4. DATE DRILLED 9 /8 -0 3
5. TOTAL DEPTH. /'CIS 6. DOES WELL REPLACE EXISTING WELT 7 YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing'_ _k•T',
(Lire '4" If Above Top of Canard
S. TOP OF CASING IS G2- FT Above Land Surface"
'Tap of casing terminated aiur below band surface requires a
variance In accordaace wish 15A NCAC 2C .0118:
9. YIELD (gpm)' '3O METHOD OF TEST 4/%R
10. WATER ZONES (depth): /3 0 30 Gem
•
279610
Topographic/Land setting
lab :Midge °Slope ❑Valley
i (check appropriate bon)
Latitude/longitude of welllocation
/i/35 a2 .00S ss °Sae/Rl. 97/
(degemilainutea/e ds)
Latitude/longitude source: PSOTopographic otap
(cheekbox)
DEPTH DRILLING LOG
From To Formation Description
© a. 04026,16 ce sD
is-2 /- : O.Za6 v5 .
� 46 )N 5a vtl
4.7 4 e - a GRA 9 /lIRAl as ca
SS'— /./5 GRA-Y r/'wick
//S - /3° P,RVY 60l2I) Rock
18o— /e.s 6Rece ET-axr7-920c.tr
LOCATION SKETCH
11. DISINFECTION: Type // T/'E Axammt -6 ' z $how direction and distance in miles from at least
12. CASING: Wall Thickneae two State Roads or County Roads, Include the road
Depth Diameter or WeighUFt, mates numbers and common road names.
Fromfa TOSO Ft.6 /F <570.2al ,U C c
From To Ft w o
From ToFt, N n�
13. GROUT. Depth n,M,'a'teri$I Method r*t o"
From _ To rite Ft. Cie cj ii zrn
From To Ft. NI L.,:
Cll
14. SCREEN; Depth Diameter Slot Size Material �b
From, To Ft,. _In in. 3 r"o
From To Ft,®t-_in. In, — ma
15. SAND/GRAVEL PACK: c
Depth: Size Material c0 o
From To Ft. z
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH ISA NCAC 2C, WELL : -
CONSTRUCTION STAND AR ,,AND THAT A COPY OF THIS RECORD RAS SEEN PROVIDED TO THB WELL p\t NER
ec, 9-/ 9 113-
S1�.v
OP PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section,1636 Moil Service Center- Raietgh, INC
27699-1636 Phone No. [phone], within 30 days. GW1 REV: 07l'2001

279262
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Diiviisiioonn�offWWater Quality - Groundwater Section
�3$
WELL CONTRACTOR (INDIVIDUAL) NAME (print) L-1.'t. N' ' '-',1 CERTIFICATION
�a 9Q
WELL CONTRACTOR COMPANY NAME 4S R?E�U1 �� U--NeS PHONE #, 1� Dl'`1S�` .
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential I/Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
opographic/Land setting
idge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
2. WELL LOC T
N +; st own.
(Street Name_N
3. OWNER:
Address
(Street or
to No.)
CoungP N \1 -
Ares code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑NO 13/
7. STATIC WATER LEVEL Below Top of Casing: �pFT
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
*Top of cuing terminated at/or below land surface requires a
variance in accords e,yIth 15A NCAC 2C .0118.
9. YIELD (gpm): // METHOD OF TEST at-X-
10. WATER ZONES (depth): 3I S US
LOCATION SKETCH
11. DISINFECTION: Type T 1 14'F Amount Show direction and distance in miles from at least
Wall Thickness two State Roads or County Roads. ude the road
12. CASING: rp e q f�gh r�1 numbers and common road nam
DePd1 gY ' or 1 1 {pt/Ft. tb V
From b To ('C� Ft. �
From To Ft.
From To Ft.
13. GROUT: Depth,t--1 Ft
From i
From To Ft.
14. SCREEN: Depth Diameter Slot
From To Ft. in.
From _ To Ft. in.
15. SAND/GRAVEL PACK: r
Depth Size
From To
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Foption
»EPTH
From T
rrl
v
<
City T\ State Zip Code
OM�3 ,
14-1b3
M
'al
Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, OWNER°
CONSTRUCTION TANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO T1 E W
yJ ohAz II II
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Lr_
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, Nd
07/2001r
REV.
27699-1636 Phone No. [phone], within 30 days. GW-1
w
0
r_

2. WELL LOC
Neatest T
tSAt L k h(i✓Ll. S3VLkL NIG)
(Street Name, Numbers, Community, ubdivision/Lot No., Zip Code)
3. OWNER:
dress y ."L,l'�—r•-,' J1
(S
ute No.)
City . Town State Zip Code
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: iS1
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 27
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 cuing terminated at/or below land surface requires a
variance In accordaneq with ISA NCAC 2C .0118.
9. YIELD (gpm): 1 METHOD OF TEST
10. WATER. ZONES (depth): tz6.31
b3
11. DISINFECTION: Type -?*'11-0- Amount
12. CASING: Wall Thickness
Depth eteir o\rW,e,ii t�t. —Material
�
Froth To Ft.(rii� SDK r • `p {)V
From To Ft.
From To Ft.
13. GROUT: Topth ' I Ma es�al 4 M A. i )
From � To (j�`T Ft �
From To Ft. i "1
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Size Material
WELL CONSTRUCTION RECORD
2792t 1
North Carolina - Department of Environment and Natural Re�sourrces- Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print)V ( ` ` 1 Y ` s-,- S CERTIFICATION facg.
y/
PHONE # nroµ3� 9i'-'J
WELL CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Lan etting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPSDTopographic map
(check box)
DEPTH
From To
b 10
IN
Forma
riptiono
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.
tts
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
CONSTRUCTION STANDSS",, AND,'THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO TT-1� WE
D/'ry`,
SIGNATURE OF PERSON CONSTRUCTING THE WELL 11
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, r-C;
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2091

WELL CONSTRUCTION RECORD
279257
North Cluolina - Depurlment or Environment and Naloral Resources - Division of \Valor Quality - Groundwater Scclion
\cf:l.l. ('()NI IRA( 10/i (I\m\IntIAI4 NAME (priull_3.eCr /__._ ( 41.1S ('F:It'I-lrICA I ION # c' 112
\iQOI k\'(N We l\ Cs, Tit, PHONE a 133.) 41.R--I'1510
1\ lil.l. CO\'I It.\CI 0I2 ( OMI'AN\' NAPIH
SI.\-II: \\'111.1. CO.\S'l l2C1-110N l'I-:it ii It/ __- ASS(1('I.\'I FP \11) 1'IIt\IIIH
01 1 apldic:lhlc) ---- (ilapl'licaldc)
I. \\'I.LI. USE. (Check Applicable Box): Resideulial QhlunicipaI/Public ❑ Industrial ❑ i\grictillurel ❑
81(111 Ioring ❑ Rccoccry ❑ I Teat Pump 1Valer Injeclion ❑ Other ❑ 1r1 )Illcl, List tJsc
2. WELL LOCAIION:
Nearest./lowly /21 (.�/1+ix-{/ Counlyl_ Led % Le,
kTtzez
(Street Name. Numbers. (t in,,nmily, Subdivision, Lot No.. Zip Code)
OWNNR: Ut/POLd7 CAN 5D^3
3
5
6. YIiS 0 NO ❑
7. STATIC WATER LEVEL Below Top ore;isiog: /50___Fl
(Use "a" if Above Top ol
S. 1 OP OP CASING IS 1 FT. Above Land Sur Elves
'liar of rasing tei initialed alfor Grlmv land sun fare mud' es a
c au iar,ce in accordance nhl, 15,\ NCAC 2C .11118.
9. YIFI.D (Lpot):_-YQ_ ME.1110D OF PEST
IO_ AWATER ZONES (depth): t 390 clot —539
.26,, q(ei /994, 1564
I I. DISINII!C'IION: "l spe Amount
12. CASINO: Wall Thickness
Depth Diameter or \\'cielll.'PI. Nl:aerial
Frnlll +I To )03 EI. &'78 SOR.c2i Put,
halo T o EI.
prom To-----
11. (iROU I Depth Maleri:d Method
Hon 0 To 0&0 1:1 Never‘ -_.. nolnrj _
I tom rn PI. Cerrteni-
I'I. Depth Diameter Slnl Size f\I:nclial
I tom llr I'I. in. in.
1 tom__ Fe ICI. in. it
I5. SAND/GRAVIiI. PACK:
Ucplh Size y Mnlerial
Addles\ a5QSLitoy ly /
IShoct or Borne Nor) A" nrz Le)11 tic 28(10.5
tie or' limp Slate Zip Code
(35 )- cis 3 z--5&82.
At ea code- Phone munbur
DATE DRILLED 9 / /1 103
"roTALDI!1'111: (aar
DOES \\FIEF- REPLACE EXISTING WELT.?
I tom Tn 1:1.
Prom
16_RENIARKS:
,4Ah-S35
/l opographiciLand selling
6)ltidge ❑Slope ❑V❑(ley ❑Flat
(cheek appmpi late box
I otihnlc,'longilude ,,I NVell loc;llion
IJegreec tuinu(cs!aennd=1
I alilodclnugiludc Snurce:❑GI'S❑Topographic map
luheck heel
1)1:1' 1 [1 I)RII.I.ING LOG
Llom Tn �"ni1 hilinn Description
- 93 0t
93 Soo fried, 6rr(.y Gr4 .bt.
y°o 5&J ivied • Sam e_b_f a(fp
c
O -c
W
rn c"
� Cr,
30Q)9-43 y
1O('AIION SKI' I (11 "o
Shrew direct inn mid distance in miles limn IeasF' rr,
Iwo Slack (toads or County Roads. Inclutcljt rota
numbers and common road names. CO —C1 L1
CO o
4Fge.D.1 RC?
I DO IIE10111 " l'liltllll' 1IIAT HITS \VELI. \VAS CONSIR(1(' 111D IN A('CORDAN( 11 WI 111 I5A N('AC 2(', WELL
CONS TIt(1C11ON STANDARDS, ANI) MAT A COPY OF '11115 RECORD I IAS 111-11N I'ROCIDED •1 O 'Il1E AV EI.L OWNER
p/1/ /03
I.
`A (INAr(IRE OF PERSON CON.STR(IC ITN(; 11111 \\'I 1 I. DATE
Submil the original to the Division of \V:Iler Quality, (;rouudwaler Scclion, 1636 M:it1 Sdreice ('ruler - Iialcigll, NC
27699-1636 Phony No. [phone], within 31) Joys. (iW-I PIN. (17/2001
rn
m
IV
CT

WELL CONSTRUCTION RECORD 279256
No, Cal - Dep;rrinient of Environment and Natural Resources - (Division of \Valor QmJily - Groundwater Seclion ^-�
G
\\El.I. COST It WI Olt II:N11IVll)UA I.) NAPIP: (unlit) y Wlzi-kln'II
S _ CFIiI IFIC\ON Hyr�'IS
\ rEl.I.(a),IIt%(-1Olt (//S I'ANN'NAPIEKidd CV.41P4"-?' ).i, _CtPlIONE a 13) 1/E3-1/26/0
.S I.\l I. \\'r.l.l. CONS] It 1'(' 11(IN PER111IH ASSOCI.\l'I':It \\ I) Pl:lr\IIl H
III applicable) lifapplicable/
\VEI.1. USI:. (Check Applicable Box): Residential Q f\ Imticipal/Public ❑ Indust' ial ❑ Agricultural ❑
Nlunituiing ❑ Recovery ❑ Ilcd Puny \Valor lujeclion ❑ Other ❑ IIOlher. List Use
AAN 83y
Nearest Town: ell re ra)ILY County C %E j2QkE C
h°II-C.IL-T2c-e L hPeS Tk+v3C.FL
(Snout Name. Nunheoc. Comnumily, Suhdiciciou, Lot No.. Zip Colic
3. (\VNER: HklZhLI) 1LC'/1_S00A)
titlor H.) /L11
(Brat or liomc No) /
tPttLL 11. tJC fls30 C)
C'iic or l own Sl;de Zip Code
( )-S37—scV1
Address
Atei code• Phone n,ml,cr
4. 'WI C DRILLED 2PI° 103
5. TOTAI. DEPTH: ]oar
(.. DOI!S WELL IGiI'I.A('I EXISTING WELL? YES O NI) Er
7 STAIIC \VATFR I.EVP.L Below'fop of Casing: ------ FT.
(Use" I"it Above lisp or Casing)
8. 1 OP OF CASING IS f FT. Above Land Surlacc'
•Top 111 casing Inrminu red al/or Ldmv laud snrrare requires a
s:ui:urre in accordance n ith I5;\ NCA(' IC .11118.
9. YIELD lupin): `- --` METHOD OF TEST /CV 2
10. AA'A 1 ER ZONES (depth): _
II. DISINI:Ic:ION: Type Cirke 12 We
12. CASING:
Depth Diameter
Flom +1 Tn //6 PI. Crke
From To Ft.
loon To IL
13. (iROLI: I)cptll blalcrial Method
"�
I-rom 0 To __-a 1_ IT. Neck* Poured_
Ilona loPL CCMer\Ic_-__
I4. SCREEN: —"- Depth I)i:Hucler Slut Size F'I:11(11;1i
110111 To__---_-
I:nnn To
15. S..\NI)/GRAVE(. I'A( K.
Dcplli Size y Maier ial
Amount _ /CL'- I/r2M
\Noll 'thickness
or Weight/FI. '.I;uerial
SD1f,)1 WC
Flom Ta It.
Flom To El.
16. REMARKS.
o€
N -ter
�\
LO('A"I-It IN SF:IiIY'I I —p m
Show direclinn and diSLnlcc in miles limn ati�(.tsl art
Iwo Slade (toads or County (toads. Include I INoa(I(t"I`
IIIIIIIhc15 nod co.,. load ❑;uucs e)
t..:/ /Ll/
11)0 III!RIi01' (1IIt111.Y MAT 11115 WRLI. WAS CONSIItU1 FED) IN AUCUItDANIT. WI III I5A NCAC 2C. WELL
CONS! RUC H-11ON SIANI)ARUS, AND II IAT A COI'Y OF 11IIS RECORD I IAS III16N I'ROVID)ED 1 O 111E WELL OWNER
1
1� opocruphic/Land selling
L. Ridge ❑Slope ❑\';dlcv ❑FIai
Inceck appropriate host
I alitudelongitude of%yell location
Idego secminoics.cccondq
I alihnlc Ion)tiludc suulcc:❑(il'SOTopographic map
(check tun)
I)RII.I.ING LOG
I ot'mation Description
Soli
1>I.I'111
Plom- In
p - /05
get - /30
130- /35
100
5-60 - 7oa'
34a _-23__ &.oSO
9I1° �o3
SIGNA IURE OF PERSON CONS( R(IC- IING l 111. WIT 1. DATE
Submit the urioin:d lu the I)icisinu of Water Qualily, Gronnthraler Section, I636 (Mail Scr\ice (-enter - Raleigh, NC
27699-1636 Phone No. (919) 7(3-3221, \r illlin 311 hays. (i\V-I REV. 07/201 T;
e

WELL gOtiSTRUCTION RECORD f
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR QNDIVWUAL) NAM (priynt)' r12»t17 1•V 1 CiU / CERTIFICATION 7
WELL CONTRACTOR COMPANY NOIR %2s U et.4_ Da(at ti& PHONE>r Z166
STATE WELL CONSTRUCTION PERMIT# ASSOCIAM WQ PERMITS
'fa licable f licable
1. WELL USE (Check Applicable Box): Residential CJ• Municipal/Public Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other l3 If Other, List Use
2. WELL LOCATI
Nearest Town: i l/%2P14V countratatETS
tutwomegc eRt<i iiLaLS 270 fluke,' I/O
(S'_tet Nuru, Ncnbcr-, Corn:mut: , 5:`«&vt iot, Lc; No., Zi C:wa)
3. OWNER: GL( 14 1-1`c f ii'
Address .270 4L-LC-t4 IRL7
eeer a RouNO )
('pi't 211-1L(STe•4N.te 31713
L7ry or Town Stitti Ll Zip Code
)- 4tk 7
Area code. Phont number _/Gy .—G3
4. DATE DRILLED
5. TOTAL DEPTH' L{7S
6. DOES WELL REPLACE EXISTING WTI 7 VES 0 N0 t437
7. STATIC WATER LEVEL Below Top of Casing:7W
(On "+" If Above Top of Cuing)
8. TOP OF CASING IS ON PT Above land Surface'
'Top of callus terminated abur below 1104 eurfas requires t
variance In accord net with 15ANCAC 2C .a11$:
9. YIELD (gpm); NZy METHOD OF TEST A 142
10. WATER ZONES ept ):
11. DISINFECTION: Type
12, CASING:
Depth Di
From go To 4-a. Ft 0
From To Ft
Front Tol, Ft
13. GROU7;; Depth, Material
Fromm _ TO Ft. GE►Mentr
From To Ft.
14. SCREEN; Depth Diameter Slot Size
From, —To Ft , in. ,
From To Ft.,�-,•jn, in,
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
Ft.
Amount - e
Wall Thickness
or W itc tPt. Material
lgg 6Ttc-i-
ieth& 10
Material
From
From
16. REMARKS:
Topo graphic/LanOetting
DRidge °Slope &&Gulley DFIat
(clack appropHite box)
Letit-L..4eliongitide ofwell1oca 8 77Z
N. 3 S 02 , 6S 6u
(dearen/ttunuonheards)
Latitude/longitude sotiroe:OGPSOTopographia'map
(abed box)
DRILLING LOG
Formation Descriptipy
ot�?uL_c- era 0,
To
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
nurnbers and common road na-Tes,
0
w
m
-o
ca
tV
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION ST AT A COPY OF THIS RECORD HAS BEEN PROVIDED To TFtE WELL OWNSit
(At
7l6-O3f
SI ATUF2P OP PERSON CONSTRUCTING THE WELL DATE
•
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raieti
27699-1636 Phone No. [phone], within 30 days, OW-1 REV.
14-n
r
r

279222
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources -Division oWater Quality Groundwater
If2ila _
Section
CERTIFI
e•�xl
WELL CONTRACTOR (INDIVIDUAL) NAME (print) nl) r r � p C �a pttOryE
...vv NAME rYA
WELL CONTRACTOK a;v'G:. •- -
STATE WELL (ON, ca ICTION PERMITS
if
ASSOCIATED WQ PERMIT,/
(if applicable)-eran.
1. WELL USE (Check Applicable Box): Residential ®' Municipal/Public 0 Industrial 0 AgricuiiU^!
Monitoring 0 Recovery 0 Heat Pump Water Infection 0 Other 0 If Other, List Use_�--
2. WELL LOCATION:
Nearest Town:
(Street Name, Numben, Community, Subdivision, Lot No., Zip Code)
3. OWNER:. D
Address
Count
City or Town
Sate Zip Code
Ares code- Phone number
4. DATE DRILLED `6' a�
5. TOTAL DEPTH. 3 S'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO `D—
7. STATIC WATER LEVEL Below FT.
(Use
U Top
"+" fAasinB
Above Top of Casing)
8. TOP OF CASING IS
FT. Above Land Surface"
*Top of cuing terminated at/or below land surface requires f
vIaccordance withIS METHOD OF TEST LL—
CAC 2C .0118.
9. YIELDELD (gPni)� --�——_----_
10. WATER ZONES (depth):
I Amount S
11. CISINFECTION: Type�T Wall Thickness
12. CASING: ,,D�ia^me�ter or Weight/Ft. �Maateriall Depth Ft.y�„ . SDC.�1 +C
Frond).— To 1 l F')
Fro To Ft.
From FL
From To
13. GROUT:
'� Depth Ft
aJd._
Froiny�TO Ft._� Sizc
To Material
Diameter Slot Sizc
14. SCREEN: Dept Sl
Ft. in. in.
From TO Ft. in. in.
From To
15. SAND/GRAVEL PACK:
epth Size Material
To Ft.
From T^ Ft.
ti
Method
Topographic/Land setting
ORidge W'3Tope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
N •1'tfpH c S( S
(degrees/minutes/seconds)
Latitude/longitude Source:OGPSOTopographic raap
(check box)
DEPTIT
lciL` twir'�t f�(i
From To
Formation_ Description
C.
i OCA`_TION S
Show direction and distance in miles ern allea.—
two State Roads or County Roads. InuWd o�pa
numbers and common road name -v e, 1
:31/
rr
16. REMARKS: �t L
AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNEK
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRU ED IN ACCORDANCE WITII I5ANCAC 2C, VI
ET
STANDARDS,
— DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
GWrI REV. b, NC 1
Submit the
Phone No. riginal (919) 7o the D33-3221, within 30 days.
Groundwater Section, 1636 Mall Service Center -Raleigh, N
276g9 1

279.2 1
•
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - GroundI' ter Section
WELL CONTRACTOR (INDIVIDUAL) NAME (pram) PHONE
WELL CONTRACTOR COMPANY NAME
f ,
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential nunicipat/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
setting
ORidge Mope OValley OFlat
(check appropriate box)
Latitude/longitude of well location
2. WELL LOCATION: County Lti �� kP�
Nearest Town (')')
— community, Subdivision, Lot No., Zip Code)
(Strtet Name, iiuuh..'.•-, -
c
3. OWNER:
Address
Stale Zip Code
City or Town
Area code- Phone number
d _ I _ ,
4 DATE DRILLED__.
AL DEPTH a Q
7. STATIC WATER LEVEL Below tTop ofse "+"
Abovegop oT�c s)
8. TOP OF CASING IS 1 FT. Above Land Surface`
*Top of casing terminated atior below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST--
10. WATER ZONES (depth):
11. DISINFECTION: Type
12. CASING:
Depth
WELL CONSTRUCTION RECORD
ASSOCIATED WQ PERMIT#
(if applicable)
6. TOT
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO FD
Diameter
From�_To �If7 r
From _ To Ft..
From To Ft..
13. GROUT: Depth Ft.
From f7 To ,2F2
From To Ft
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK: Size
Depth
From To Ft.
From To Ft
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO WELL OWNER
Diameter
Ft. in.
Ft. in.
Amount 15
Wall Thickness
orr�W�eiight/Ft. Material
.]uy=
Method
Slot Size Material
in.
in.
Material
A -fs" tJ ° I „ i
3s !
(degreeslminutes/seconda)
Latitude/tor2,hide source:OGPSOTopographic reap
-!.rk box)
C.nC,
.DRILL "
Formation Description
DEPTH
From To
w
w
______ h
Show direction ndT� m s a t' t
two State Roads or County Roads. Inchide tlly d
numbers and common s ad names. _ rn
O m
y.
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit GW-1eREV. h, NC
tt the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, N
.thin 39 days
27699-1636 Phone No; (919) 73S-.iti.i.'n'.............-,,-•
DATE
.r;

WELL CONSTRUCTION RECORD 279217
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
W �� Gp n CERTIFICATION Rr:4OU
WELL CONTRACTOR (INDIVIDUAL) NAME (print) 7'.mA j R PHONE N ff7 9 i 8� i
WELL CONTRACTOR COMPANY NAME M,\IvC t+)val 4c.\I•nr'
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential lid Municipal/Public D Industrial D Agricultural D
Monitoring ❑ Recovery D Heat Pump Water Injection D Other D If Other, List Use
2. WELL i.......-_
. CCATICIN•
_
County Chad r,ko e
Nearest Town:
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: , e-kiCSA Srot n
Address n P
(Street or Route No.)
AnAV e-U3CaNC 2Q9o\
Zip Code
City or Town State
Area code- Phone number
4. DATE DRILLED <6 - IS - a 3
5. TOTAL DEPTH: I S.
6. DOES WELL REPLACE EXISTING WELL? YES D NO El-
7. STATIC WATER LEVEL Below Top of Casing: 020' FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface`
'Top of casing terminated at/or below land surface requires a
variance in accordance with I5IvNCAC 2C .0118.
D OF TEST , Q
9. YIELD (gpm): 'r
10. WATER ZONES (depth):
11. DISINFECTION: Type i4% poI(o s
12. CASING:
Depth Diameter
, From n To '70 Ft. 4,075
From To
From To
13. GROUT: Depth
From_(2To ,)0
From To
14. SCREEN: Depth
From_ To
From_ To
15. SAND/GRAVEL PACK:
Depth
From To
From To Ft.
Ft.
Ft.
Amount \ S
Wall Thickness
orWeight/Ft. Material
SDQI pv(
Topographic/Land setting
DRidge ❑Slope Walley ❑Flat
(check appropriate box)
o;itucle/longitudeofwell locat�s Is r
t\) zz i2 clAr vJ%3
(degrees/minutes/seconds)
Latitude/longitude source:DGPSDTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
- an '
an - (00'
Con' - 1 S(.5 '
Material ` Method
Ft. (l,')t \ nn id. RcesSuirf
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
I4
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names. o
W o
�I p
rn T
om
J
0
o<
Ern
vo
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
- ) S� n-.$ - --
f._...y. i,., DATE
SIGNATURE OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality' retmdwater Section,1636 Mall Service Center - Rale gt h, NL
y,,,C...__OW-1 REV.07/200i
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD 2792,14
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION (I,-?Va it
WELL CONTRACTOR (INDIVIDUAL) NAME (print), 'U'MG.S R. 1,),\S C\
WELL CONTRACTOR COMPANY NAME Or) i t) 0 r ( ,JQ.\l 6r:\)„er5 PHONE # ( )
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential IW Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:JYlt Ar
(rn,ck
(Street Nee, Numbers, Community, Subdivision. Lot No., Zip Code)
3. OWNER:irzonq< C ,� \(Mc)le
Address ) f t.2 Drdd(a 4J I r c'P P k Prt
(Street or Route t4o.)
yv),,(01- r).c. 2R90(o
City r Tocvn State Zip Code
County( VIPrnkee
Area code- Phone number
4. DATE DRILLED f *- (/- 03
5. TOTAL DEPTH: SOS
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0--
7. STATIC WATER LEVEL Below Top of Casing: 70FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface*
flop of casing terminated at/or below land surface requires a
variance In accordance with 1SA NCAC 2C .0118.
9. YIELD (gpm): C METHOD OF TEST A iQ
10. WATER ZONES (depth):
11. DISINFECTION:Typenkk yellpri-s
12. CASING:
Depth
From fi To
t From To
From To
13. GROUT: Depth
From(_ To CO
From To
14. SCREEN: Depth
From_ To
From To
15. SAND/GRAVEL PACK:
Depth
From To
From
Diameter
Ft. (.o::2E
Ft.
Ft.
Amount
Wall Thickness
or Weight/Ft. Material
Material Method
Ft. enr4Ir.nd prP.ssure
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
Size Material
Ft.
To Ft.
Topographic/Land setting
❑Ridge EISTope Malley ❑Flat
(check appropriate box)
Latitude/longitude of well location
e,i.P e.irn."iireslseconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEP i H nRILLINQ LOG
From To Fogs.TT'ion Description
0 - 00 r+
- CDs' Crh, le 1
LOCATION SKETCH I
Show direction and distance in miles frorb at least 11k-�--`
_.-
two State Roads or County Roads. Include the road
numbers and common road names.
Dr
0
w
cc��
�m
�
N �rn
c
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
(Apt:- Qna•vt,
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
ntq.: 'Then,. No. [phone], within 30 days. GW-1 REV. 07/2001

2. WELL LOCATION:
Nearest Town: MURPHY
MOCASSIN CREEK
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC.
ASSOCIATED WQ PERM]TN
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial 0 Agricultural ❑
2 9023
CERTIFICATION N 3295
PHONE N [phone]
Monitoring 0 Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topographic/Land setting
DRidge ®Slope ❑Valley °Flat
(check appropriate box)
Latitude/longitude of well location
County CHEROKEE
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JOHN PANAGOS
Address 382 SCOTTISH WOODS WAY
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Code
( 828 )_ 837-5678
Area code- Phone number
4. DATE DRILLED 08-29-2003
5. TOTAL DEPTH: 305'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated aUor below land surface requires a
variance In accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): 20 METHOD OF TEST AIR
10. WATER ZONES (depth): 220'
11. DISINFECTION: Type CHLORINE Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
12. CASING:
Depth Diameter
From 0 To 115 Ft. 61/8"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. '
Slot Size
in.
in.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TU4t A COPY OF TI RECO$J? HAS BEEN PROVIDED TO THE WELL OWNERsr—
. i
(dcgrees/minetesheconds)
Latitude/longitude source:DGPS0Topographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 60' SAND
60' TO 95' RED CLAY
95' TO 115' GRANITE
115' TO 305' GRANITE
BIT SIN 30224-63 SIZE OFF © 6.060
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.
UCTING THE WELL
DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1616 Mall Service Ceenter' RaleiRBVgh, NC 2001!.
27699-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) IARRV F. JONES CERTIFICATION # 3295
PHONE # [phone]
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC.
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
279095
1. WELL USE (Check Applicable Box): Residential El Municipal/Public O Industrial 0 Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: DUCKTOWN, TN
BERGERTOWN - HARRIS RD
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: JAMES & DONNA HARRIS
Address 453 HARRIS RD
(Street or Route No.)
COPPERHILL, TN 37317
City or Town State Zip Code
( 828 )- 494-9987
Area code- Phone number
4. DATE DRILLED 09-06-2003
5. TOTAL DEPTH: 465'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'"fop of easing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 6 METHOD OF TEST AIR
10. WATER ZONES (depth): 260'
County CHEROKEE
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 98 Ft.
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft.
6 1/8" SDR 21
Material
PVC
Size Material
Topographic/Land setting
❑Ridge ❑Slope OValley ®Flat
(check appropriate box)
Latitude/longitude of well location
3502.938N/8418.747W
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 60' RED CLAY
60' TO 80' SAND
80' TO 98' GRANITE
98' TO 465' GRANITE
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.
NG
4
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAT APY OF THISCORD BEEN PROVIDED TO THE WELL OWNER
2 9-6v3
SIGNA'I{JRE OF P�p{SON COSTRING THE WELL DATE
0
0
C/3
n
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
11

WELL CONSTRUCTION RECORD z k 9 i;„'�
North Carolina - Department of Enviromnent and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION If 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE t 1828) 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITH
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
VIOLET COMMUNITY
County CHEROKEE
(Street Name, Numbers, Conununity, Subdivision, Lot No., Zip Code)
3. OWNER: DALE MURPHY
Address 144 BEECH LN
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Code
( 810 )- 621-4373
Arca code- Phone number
4. DATE DRILLED 09-03-2003
5. TOTAL DEPTH: 165'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING 1S 1 FT. Above Land Surface*
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .8118.
9. YIELD (gpm): 20 METHOD OF TEST AIR
10. WATER ZONES (depth): 90'
11. DISINFECTION: Type CHLORINE
12. CASING:
From 0
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Ft. CEMENT
From
To Ft.
Amount 100 PPM
Wall Thickness
Depth Diameter or Weight/Ft. Material
To 50 Ft. 61/8" SDR 21 PVC
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
Method
GRAVITY
Slot Size Material
in.
in.
From To Ft.
From To Ft.
16. REMARKS:
"Topographic/Land setting
❑Ridge ®Slope ❑Valley ['Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 20' SAND
20' TO 30' RED CLAY
30' TO 50' GRANITE
50' TO 165' GRANITE
BIT S/N 30224-63 SIZE OFF @ 6.060
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.
5`
9
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITII 15A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND TIIAT A C 'Y OF THIS RECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
SIGNATI E OFF SON CON»IICUCTING 'HIE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW- 1 REV. 07/2001
PP

Ninth Cal ulioa'- Uclruhndid or Environincn
is'1l.l. l IIN 1 ItAC'I tilt (INDIVIDUAL) NAM :l( jpilnl) RR 't
s I A l i( \1'ta.l. ('ONS'I IUV('I ION FERIAE'. i. ai `, - j' ASSOCIA tF.1/ WOPE.Iu'ItI N
Of applicable) (if applicable)
I. WI. LT USE tCiicck Applicable Box): Residential f� NI in cilia1Public d Ineldslriai 0.Agricultutal LI
Nlnnital nig LI Rccoecry O Ilent I'unip Water Injection 0Other O If Other, Hsi Use
WELL CONS'1'1ZUtTION RECORD
Ro t and Natural c [llrccs 4 Uivisiol of Water fluid
\tF II ro.InACIOIt(U\I I•,\N 1'NAn1Ii keRokee:, J011llrn
274812
2. \VIII.1. LOCATION:
Nearest Town r AQI2Q-03 County Q_
Gpcw Sect I/ZPeL
Itinror N Numhci s. ( Lot No-. Zip Code) ,
3. O\\NFIt re.S f o oF°R
ciao H),Iy
iAd:hcss
I Vied nl Runic N )
A'wewS' n)c �390
l ily n, 1 n ii is Zip Crete
1 )w 3a,
At rode I'houc nundn r
d I)AIFFURII.1.I;N (a`fO`03
5 'I OrAl,
6. NOBS W'IWLI, ItII'LACE (EXISTING WELL'} YES O t-i 1
7. S FA]IC WA I tilt I.Ii.VEl. Below Trip cruising! ' ---_.H_IrT. •
' ' (Use"4" If Above Top of Cniingl .
1 OI' 01. CASING IS 1 IT. Above Land Surface
• lop nl r.,<In{! terndnnitd d/nr brinst land snrIitt requires j ---'
i:nlnnre Iu nlrordmnr nlih I5A NCAC IC.011N. -
Q. ti'IWI.1) 112.1)10.:__- METIIOD Or TEST Alf-.
Invv'AiFit /ONES(deport: /COfan°I
I I. DISINI`Il(.'1ION: Tvpl_� �NQ Amonnl /oQ /
12. CASINO. Wall Thickness !
Ikggh l);io lYr or Wel'It1/FI.' 'Matoial
I win__ _'fu,__/3Q_ rt. G17Y r •/a
How To Fl
Ilrnn 1'n [ Et. . --
1 i. GROUT` Depth - Nlalcrinl Method
1 Ion U To `1-E) FL' CemeiT '1Qfi✓
ono to it
1d. Ni 121:I!(I: I)cplh Dianicles Slut Size Nardi;I
I into To hI.
iu.
!HMI l i I:I.
15 SANIV(iRAVI1I. PACK:
Depth
I loin Tl i__
I lilii ---- Iil
16. Itf.NIARKS:
Oro III PU�01';I,rrRl',II'
44*V4J 14-444fitl S t
1..
11
Imo
. rh)ntrIIseoI-i+giiln uthe
17(.rl'Ittfih Phonepi-6 ) I'))7
Mnierial
ily - Groundwater Section``�o
CERTIFICATION 1 •b S
PRONEH 1$58 cg37-IS 0CM
ropngrapllic/Lan .citing
Oltidge OSlopc Valley ❑FIaI
(rlicrk nppu:pt late ho51
I Minnie/longitude of well location
(drgteesio0uul rs/seconds)
I.:nlimdc/longiludc snulrc:0(i1'SOTopographic malt
(check box)
DRILLING LOG 'I
I'nrotation Description` '
u
I)LI'III
_C)-130
_L3a -)15
(9.Mr4T C
LOCATION SKE] CI I
Show direction and distance in miles from al lens)
Iwo Shitc Itnads or County (toads. Include the toad
nunihci5 and common road dames
0
(A)
t_
es -
bin) 11ika
I TIIIS WP.LI, S CONStlkIJ ED IN ACCORDANCE WI I II I5A NCAC 2C, WELL
3S, AN1i 1llJ'Aj 0l'Y,OF I I I :CDR 4I AS BEENI'ROVIDI'.0 TO TI IE WELL OWNEIt
S?NA'fURE ERSON CONS. IN01I11i WIELI. DATE
/ivlsion or Water (1Uallly, Groundwater Section, 1636 hi all Strike Unier - Raleigh, NC
33-3221, within 30 Gays. (1W-1 REV. 0712001
ti

274811
• WELL CONST1tUCTION ItECOItll
rJ,nlli I an+linn - I h•p;uhncul of Environment and Natural Rcsaincres - Division or Winer Quality - Groundwater Scclion p<
nl I.I. I IINI IRA( IOIt (INDIVIDUAL) NAMI: ( ratr) R(,'✓'�r�,r`�1. I�Dp"�'�(-5-.-.-_--(- --- CEIUWWICAA�T IION A' 3c}15
la Ill I IIN I ItA( Wit (.(1\II'ANV NAME 6(,enotte� L Lt D l"L"I& I'I ION P ff/.ia) FV-ZI1
SI,\II WIII.1. ( 11NS Ilit'('110i PERMIIN ASS(1CIA'I El) \\I) l'I:ItjI1ln
I i r;ll'f,l icaLlcl (if applicable)
I. \\'1.1 I, I ISF ((heck Apjtlicahle Box): Residential /Municipal/Puhllc [ htdusnial 0 Agricultural ❑
M nnipninit ❑ Reran cry ❑ Ilea( I'tmlp Water Injection ❑ Other ❑ If Oilier. List Ilse
7 \1'II I ( )('Al ION •
.
.. Nrairsl Ilnvn' Al IA r)-I.
f:nrrt Nuns. Nnmhn I',mnumiity. Subdiviciet( Lnl No.. Zip ('ode)
OAA NI -It
gl 1 l Sj Ive,�
Add,es.--.___�a57 Z _—n� --
pot! n, ItaWr��cioG
/�tuTit/ r
ihi I
County 2u�-Die
b l: l' I I I
Stair Zi+C'odc fnnn "
IS-25 )- 737— 1,5 S� 0 -- yS
„or (hula ntlml:M r r A%--_3oS
•1 NA1 UItILLIID
5. IOUAI, OI?I'I C.___....3Q.5-_ _. /
('. NOI'S \VE.I.I, I2E1'1 AEI'. P,XISTING WELL? YIPS [ NO fVf
7. S 1 ,\11(' \\'AI Elt I,1.\'Ii1. Below 'fop of Casing:
(L)sr"t" if Ahove Top cif Caring)
8. 1()p OF CASING IS / ET. Above Land Surlaec'
in, or citing lr.nJnntrd nt/,r I,rlory Inlol ,irfnre rrgnlref f
:u laarr 6, nrr,n Jnnfr alto IS,% MCA(' ZU .III IR.
II. INTO -..-_-METIIODOr'fEST �%/n�—
III \V:\ I lilt tows (dcplh):
fnlmg;:Iphic/Lnnrl selling
Ridge ❑Slope [Valley ❑Plat
Irherk npprop,ialc box)
I.alittule/longitude of well location
I do gte' hnin ole s/sect nuts)
Lalitudr; inngitudc sow cc:❑(i1'SO rupogiapltic map
(chrck has)
DRILLING LOCI
Pormalion Description
DIRT cf- ( 41k°/__
S�rrrE
LOI AI_I(IN_SKEI CI I
11 . 1'IMNI lir I ION: .1 vpe_(kf dg.JW _ Amount _/.2_ / 4& Show diicclinn and distance in (riles how al leas)
I ` I ASINI is Wall Iliickncsa / Iwo SIale (toad: or Cotiuly (toads. Include the road
Nrptl, bringer or Weight/Et Malciial numberrt and common road names.
111,111 Q in
1 1:,111
1 t1,11t To fl.
1 l t I (IIJ 1bcplll ��Ni tie Pal hlcthoil
I tool 0 lu dL IT&estei)r
1 I,,,,I_.iC) _ 1„ ilea_ I i ..C'd tt LS_--- -4Ra✓i <Y
I 1 S(' TIT F : hcplh bianicter Skil Sin, Meliarill
I uan to 1 1. in. in. ..._... __
1 n'n1 Fri Il. _-- in. in.
15 S,AHim GItAA'O, I' V(-K:
Depth Size Material
I toot 1 n Et.
1 min
1
---+++1-rttrttYll,� (1"RTIi' j' � � Ai- Tills wE.l.l, WAS C'.ONs IlttJ( -I I:U IN AC('ORbArJ('E \cl I I 115A N('A(' 2C w1iLL
( )1T-: II11• (I( SI AM{.) DS,AND ••IAT ACO2S/E*l111S 12'CORIIIIASOI.EN 1'RO\'IUfb TOI11E WELL OWNER
SIGNAI
rn
i I
6 -C2.V3
S'I R11C1IN(t 1111( WId I. I)A11i
vriln SELi
S E„'(tLt'nnrt tlf?'f('{iit+MlL6t Ihr )ivlslon of 1Paler Quality, Croundwatte Seel Ion, 1636 Mall Ser\ice (_enter • BaIcIglr, NC
% l f Plumy Nu.ON) 'ti:1221,nitlii 311days. ' (i1V-I REV. 07/2Upl

274810
WELL CONST1tUC1'ION 1tECORI)
N,nlh 1 -:,ruing - Ncp:uuncnl or Environment and Natural Resources - Division of Willer Ouglily - (itoundwatcr Section pC
vlll IrTltt.\1'IInt {INDIVIDUAL) NANF. rinl)__�IRR '^F �(.�G'S._ __ __ CF.Il11FICA'I ION M
Will I IISI It41 Wit( I)\II'AN1 NAME beKo y_I,�eI i ._._�RI I I Ia -._ I'IIONE M f�.%) g'37__ -
s l.\II nl:l. I. ( IlisS11(1'r IION PERMIT*, ASSOCIA'I El) WI) I'EIItl I
l if alplicablcl (if applicable)
I. \\ I l I. I ISP 1(hcc1. Applicable Box): Res lenli1lt< Municipal/Public O Indust, in! O Agricultural 0
I\IcIIilnl inw L] Item,. cry O Ilea( Pump Water Injection t] Other Li If Oilier, List Use
1. AVI I.1,1 ( µ'V I I OM.
Ncmcst limn "Ltr-tp
L-w2-C9tt&-E L-4NC
1':n rr1 Nmnr. Numhrr•:.1-,nnlnunily/,�Sl,lihliivvi<inn, Lnl No_ Zip Code)
I 1)WNI'It: S(n& % N9L.S
Adrhess
Counlye = 2. F
ki
..��cnl nr Itnulc-Nn.) 2-`6 /�
s 7 —0S --/Da
4. i IA 1. mu ri) In 5-C1.5 Fyn _ -QS
5. mint num- Sn•S" 6/
innVI I s \I.1.10'19.ACP.IiXISl IN() WELL? YES NO IN
7 STAIIC um I. I.I v1:1. Below Tun of('asing: 'C) rT.
(Use"1" if Above lop «WCasinp)
S I( )1' O)" (ASING IR 1'I . Above Land Sur lace'
I op nl r'lone Irl mhnlyd hl/nr brlob Iarlrl nnlare tegolrm a
Hot In nrr„raanre null I5A NCAC 2C .01111.
I). VII'I.D I(:pul): /0E)ME Finn Or TESf_f�/�
In U•t11 Ill' ZONES Idcplll): t'/D
Plot I)lI' I -II
( tic ��r Ir,.n St;ne Zip Code 1'nrlll it)
1%
wn rnilr 1'Icnu nnn,l,ci
jlbpngrapliic/1_and selling
(Midge OSlnpc OVnllcy Orlin
(check epprnp ialc he()
I.alilude/longiludc of well location
I plc r'cc'u rinnlcs/s cc oath)
iturit'Iongiludc soulce:ail'SOlopogtapllic Map
Idack M,$)
DIkILLING LO(i
1 (10 iali10 Description
C
_524-74-
5L.n Tc
LOC'.ATION $1SETCII
I I. UISINI1 ( 1 ION: 'I -,In— �LVQI" E Amount --IS%L'2 (MLn Show dirccliun and distance in miles From al lead
12 1'ASIN(]. Wail'Ihickness two St:de ponds of County Roods. Include the road
I)epth �/ Dn uurlc ur Wcighl/RI. r.I icl ial numbcls and common road names.
I n,mQ f , / 1.c H. GA" 5bR 7-f f ✓c
I ton1 To ---- 1t--
I ll,n1 To 111.
I} IIROI) 1: Depth )��r Nlaiclial Method
I loin )__ to ;2" rt. (-- (ste,r Ati"✓iry
I Ir,n 3c) _ I.n ;z (.. rt _-C`-_aiiinJ fs orvi-f
Id. S1 " Itt)N: IlcPd, Uimnetcr Slot Size ill
n,u1 II...
110111 lu
15 NI11(iRAA11 I. I'ALK
I L pill
In
I II
1'(nn
1 11.111
I-(.._.._--
Size hlalerial
rl
II.
I I to I It I'PII\ CUR I II �0II III .I\ 111115 \VYi.I, WAS ('ONSI1ttl(' I fl) IN AC('UItuA(Ic I WI I II I5A NUM' 2(. WIELI,
(1tt4':I III IC I I(IN SIArjll I. S,AND 111• A COPY ( /fIIIS ltl(CUIt31) IS I)P.P.N I'ROvl1)11) 1111l Ili W'Ii1.1. U\VNEI(
I
II F'uhlnit the !it i) ival-+rrth>,TT'vision Ilr \Puler Quality, Ground)) tiler Section, I636 1\ 1311 Sea ice Crider - Raleigh, NC
276'1I 161h I lame Nil. Or)) 75I 3221, nI(l In 11) days. ' (iAV-I ItI.1V. 07/20111
SIGN)I'I'IRSUN (.' IS RUC IN(I 1 Int \5CI.1. DAI'I:

274788
11'I,LL CUNS'l'IIUCTIUN IUSCiii:..
;�v P� ou
IJ o1111 Cm ollna - Depal tumid of EIIvllolllllenl cud flnlural Itenoure\cs - I)Ivlslun of Wider Quality - Ulouhd"nler Section
n ELL CON 1 RACI OII IIr+,I%IUUAL)NAeIE WWI) CERIirltA,lr,nI
scCIA.
lFi �, llC l,i� rIION¢ r (%1-1'71i it
r, I,L COt+I UACIt1R COMrANI' NAM F. I ^g ,OCIA�I VD tvt) fF.IlPI11M ,___-----
SfAfF,n- ELL CONS DtilUlION rF.IIM1U_ -- if nitli cnblc
if n i licnblc
I. WELL USE (Check Applicable Box): Ilceiichlinl IL✓Muuiclpnl/I'uhlic U 11011 11d LI Aglicullutal U
Mouiloliug U Itrcovety LI Ileat I'uugl Willer InJeclion LI Oiler U It (filter, List Use
'fopo(Onpllic/I.Inhl ceiling
2. W al, LOCH I ION:Wl1Jgn 1 ISlnpc Ipry nllcy Upinl
VcnlcsI rncllf 1�_-
_ Counly l—J'SC>th-E" NISI itenitI e hoof
1 . �1p4 ,(C,cv _ .- 0 ,/&v_e _e:esA----' I ntIluJdluugih' of well location
f 11v, $abdi vidon, I d IL 71p Crvlr! Jn C� C! o ilk'�Z_
ICllrtl thine. Numbs r. ��:::: _�" �0-+--.
Lnlilu ddI^IIu'ihnle 5uurce:Li 1l'Si-1 l- upnglaphic or'p
MULL (direr btu)
y/Il1)-I,11J17 I )
1'lulu lb honnalion Ucsc+ilrliun
). OWNItit: c%f'lP (s
Atichc55 _phi./--
ISlutel nu Itouie tin.)
SINe 711' Code
pry r It ! / / I
( �r)r-___---" 7 1
AU" rr.I r. 1'brnr 11)_rr 1� l
5. DAI I? DillillIIN 1�--�---- ��--��CC .
S. 'WEAL D81' 1 I L_a�is_ -------- n.c.:
(. DUDS will, ItEI'LACE. EXIS IINN W ELI;/ YES U NO LY
1aL-_FI.
7. SI-Al IC \VAI-Ell LEVEL Ilclut,ll!r"V' If AbovTop f le Ion nl Cn,In0.)
FL lYll' OF I'ASiNt! 19 __ i _._____ p7. Above I.nnd Sul filce'
•Irr rl riling In min•iti: 4rry 1..1... b:lnui•rr 1(lath
, nInn t In •rev II" a nllh ISA NCAC IC .n1111.
Q. YIELO(rino): 1D—.__Mlil11(717 OF IFS l' g
III. WA I Ell TONES (Jrplh): _ --
h— u
I1. S CflN:fypc�Q11a S Amount _AS.
b Show dirccllon mid distance in wile, hunt nl Ic.
.I
IZ. CASINO: Wnll lhtckncne Ivu 5nIe Ronde or Courtly ;think. Include Ilie toad
4.4 Perth !thunder or Wright/IT and common fond hals.
Flou�(L— fo� 171.6__SY� � -
72a- _
:to.
lnn' 11_ -
13. (lOU f: hgdlpinlrlint MclhodIltt- To_ _ -
Flom in T 5� ___ —
F1now---__ - -- - - v, .-
10
Uinwcicl Slot Sim
IA. I IOW 11J Ilcplh 1 ill 111, Vi r
NJ
15. SANU- /0RAVU1, I'ACK: Mnlrtlnl .1
Depth Site
Now_ to I71Nem To Et.
& f-tV
f isII L
��� I - I� 5 WELLOWNER
n77l�I ION siAN I , ANU mis 111AF A COI'Y ult III S RRECUR D 11AS BEEN I'1tUVIULU l0111B 0
CUNSIItUCIION SIANI�il�l3 23 2
—A1E
J 1SIUNAIUIUSUFI'EIISUNCONS IRUCIINUllIEWELL
ern
A` ¢ ` VI,IILtitttag_l_1 I I 'I+Inn of \Vnlrr fluidity, GlourtllrnIer Section, 1636 Mall Set%lce Cenierl ltntV&I, ri :
1769e-1636 Vllnnt No. (919) 733"3/11, nllhlii 311 tiny,.
a
'Ifo`a,�cz

W'ULL CUNS•I'ItUC7'IUN IU Lvi:•1
lA ,cn� Nmll Cntulina - Urpallututl of Euvlonulcnl nod Halm' Itesuwccs - Ulvlsluu of Wale' ((wilily - Urouudw Met Sedlun
(plug celulrlCA IUtl ��OLi
as F.LL CON I IOC"1IIIl IINU11'11, 11AL) NAMErA IPdI PIIONP, Il iF61=2y
w tLt, cur,' IlACIOn COMFANY NAME. �) ) ASSOCIAn Ell avt)rP1IP1111r ._—_—_-
SIAIF, tefl.l.CONS I1111C1IUN fr..IthIIIJ__ — itnld able
it n, limbic
I, Le+limb[lox): Ilea : Ilcsidcldinl hKM'l1licipnl/Public U Im11191 inl 17 Aglicullwnl U
v y(, USE (Cheek '
t`Iuuilnliug U ItrcovCIrl y. U IIcnI hoop \1'nlcl Infection U Ulhcr U If Other, list Usc
1 opulnnpllid!•n1I11 selling
Ultidge (_ISlnpc IQ- Iley
(dirk nppugnI+le bn4
LnIlludeJlullgilude of well lucnliun
Mrif5.CCL.-c. V i3F44•5
Idep trJminnlrt/sc'^ndq
Liitiiu -,fIntIQllade 50111ce:UUl'SL I fopogiipllic nr•j,
(clink I,-”::
Mall 1111 I.Ilrti LU_(i
°runt lb 1 Porn alien nc,ctipi;u::
2. (t'ELL LOCALION:
�
Firmest I olvot mU<
_ __Cvwlty P_t_
len/_
l Q -�`� IL. Snbd inlon. l.d Na • 711' G•Ir)
IClrttl ?Mule, C....
1. OW 1:.It: : -3\rN-._ — 14
4L XA6 CSC ll lY r N�
AtItIlccSi �
Isli er! or Rohl- Ili.)
City rl Iron SInIe
�QgO5
Zlp Code
Atrt tN'r I'bonr rmntbn
.1. iAll? UIUI LI!U --d
5. I0FAL11E1'111;_l-25'-- -- IV
6. nVL•S WELLILppI,ACI:, FXISI IMO WELL.( YES U No
7. S IM IC \VA IElt LEVEL Itclollll1rllrrof CItIf einr i„_JQ__ I-1
R. I t rI CASINO IS _ _I___.o--
1' V. Above I.nod Silicate
.irI, rl titan! In n,ln.l r,t .nit Lrlon !owl nuore,r:pol r,.
r uM1nit fhi arronleive milt 15A NUM' IC .nhlp.
o Yn°LO (Frio. _ta._ __ bin-1 Ilan OF fr:SL �____ ---_— ---- _---
Ill. OVA I -(ill ZONES (Jrpol); __ -- 1.-VS'A1.I1)14 SI EJ G11
Slow direction mid dislmtcc in Miles Nnul ni Ienal
11. CASIJfIiCIION:'i)l
Ic Nnuvul LQ� Iwo Slate hands or Courtly Ronda. Includ' Ilt !owl one
44
\Noll l Idcknrss uunl6crs nod common tund umncs._-_, S
IL CASINO: LUf I. klnlainl N�\
17rplh ,U�in �wt/eler wry\�Vrdy M. c �ey��y� ,/\�,
la m-I'I. \Jt 'R� ! f I:4; /ele 1/
I�r Pll� �W.tpE-_�
\ j e
J , Ncl/
i—fit
274787
I.
11 pm_
In i't.,__. ___- Melll(Id
I IRM)tiiii_ I-__ {� hlnnllydn�l/� (rLr-
I �. I ltnll l : IIr __n. 1'1. 2]i11avic
I10111 •U lo,T�
Pnnn___ I1'-' .I. Uinulelct Slut `Sire Mnlclinl
11. SCir L•1°rJ• poi 1, S�GCC
Flom = _ - LI. iu• ht. L-1
Ill _ 11. 11!.
15. SALIO/UItAVEl, PACK: tlntulnl —
Drplli Sire _
1t1/111 Iu__El.— �—
hum
16. II(~�Alif St =— Qc �{ ��ee
rVAS CONS
I Ul 0il�`I I0N151ANUAItU5, AIIIMJI(UI\A COPY UI 1111S ILECOILU IIASAICI RD IN ACC() IBEEN I ROVIDEU 10111E WELL OWNER
Utll
12 Jn fn Nr�-. — -- 1
SIUN-IUII!OLI'EItSUIJCUNS11lUCIINU111UWL'LL UAIL.
I.RCI. 1 - ER S-. JIJN
�i1SIGfi11 AV ttrt- QanllIy, Crouutlrvnler Section, 1636 Mall Service Cullerl ItnieiILLr`1Rh, ra:01
Sul -16ll 3 ri mitflu.191� r
11(•ns-IG161'bnur No.1919) 7yJJlll, nllhht 311 cloys.
etc e- ciL
7
Y CACji2-ny�s eE f<
3 �"o
(nx
G
2

274786
WELL C;UNS'1'1,lUCT1UN IUsC OAU1
I .Eiivliountcltl nud tlnlurd Iles LIl e - Ulvlslun of Wnlcr (panty - Clluuudw'nlct Sccliuu
NoIU,Cmuliva-Ucpa,i;;:,.:�'".f ccnuncANONN—�'
Nsr.Lt,CON IRACI011(INt,I%1I UAL)NAME, tr'l„�t)�,Jf�r� EllUNE IIrA$831 g<21
nrLI"CNN INACIOfcUNIrANYNApie Ii1S. ASSOCIAIr.IIR•t)rF,Ilr117N — ----
SIn1EnrLLCNNsrnucntrNkLnnnlN iTnldicnblc �.�.-�--�
it n � dialLlc
1. WE'LL LISP, (Clirrk Applicable Boa): I(csidcutinl Ili-- Municipal/public U Indust) ;al 11 Agticullulnl U
Monilmillg U Ilecovcly LI Ilc:d I'.Iniip Witte! Infcdiun LI Ullicr U If Other, List Use
'fmpuglf phidLnitil nelliug
2. tt :bent UCA1lUN: Ullidgc kiSlnpe LIVnllry 11FInt
��"" (;utlltl)' (eller4 nppn.rllnle I��.I
Ncnlcsl loannu:aa i- - -.___
u_Yace,__I fi. —_ `i., 5 I tli kb , Lml Nn., zry• C,lr) 1.n111uddluugilude of well Iucnliun
IL> .:Y�
nee! Ilnme, Number%Ci:::^.. t y -{i"'- �--
ldepree✓uJrml^✓tr•rtulg
1. O W)11:ll Lnlilu �rl'mgiludc suw cc: Cl(11'SC1Tapuglnphic nsgl
. -1 l . Idled L l
AJdtcss ----- lllU!,UtJU LUU
I51iri'\ pnule lln.) h pU, !)I�U.Il
�1e Co ai) Llulll llt lonnalion Pesci;Wiwi
�l)-_ Slnle 71rCn,Ie J ' ^/GI
Clip a Im` �------
.I.AtA 1 1' II tit
. UAfI? UI(ILLIiUa
6. UUI?S WILT, IU111,ACI'I li (IS 1111U 1V1'.1.I3 YES U NU 1°l
7. SfAl IC \VAfEll LEVELLEVEL1)dot'(Jfi°I'rItlfAbme I�Q--
v'.olCn'Ima)
ISING IS _\_ _.___ F I . Above l.mul lullhcee
•
g. "I r GE CA, -
re nlwin! In ndn den dent lido,. hind en:l ll Aer IrgnL re 1
',ThumIn fttnl.l.itte ',lib I5A NCAC IC.
MI?IIIUD UI'1IiSI _-_ ---
In. \VA IEll ZONES (depth): _ ---___
1,---- -I- Sv -J 01
SI ow ditcdlu❑ and dislmlcc in milts limn( ill Icad
au Amount _)$" Iw 1 Slate Itunds of County Ilmnds. Include the toad-
11. C S CASINO!
LIU)rplll c�> Vall-ILickncee O
nu abets mid common toad mimes. e.)
IZ. CASINU Ilrplll t IJimucicr u`l `h1'�chRhJVfl. 1M1tnlvlinl �
f How —
Ilom l ^ -- _ _
how_ WC(C Qd, ___
how_ I n_._ 11 Me hod •�
I)c Illt Mate�r�ial nt
bolo_ (�--.Lt,ll. .liu�Y"/4!L 7` _
nt
pI` -- Mnlcl inl
Born-- It_._- e _
uI tJ• Nq,ll, IJinumlcl Slut Size i
1,1, SC...il' In.
',t, Il._._io. t
floor — - IT in. In. ___- 0-0halm- __ Iu—.--
15. SAI111/UIlAV111. PACK: Mnlulnl
Depth Site
llt 1'1
Ilolll - At
limnI° --
o-
Cil
I L�
VI I" WAS CUh1S I IIIICI I!U IN ACCORD/MICA!MIl I A(
I I SA IIC. 2(7, veLl.
C I�I UCIRIM SIANUAIU)S At�l 11'� fACUI'YUI''IIIISIUiCUIIUIIASUGLtJI'1lUV1U--� ��1�7��L'W�LL�V��
UA1 L1
SIC tIA 1 Ill! UI' 1'LI(SUIJ GUNS I IWUI U1U — 11111 WELL
Gn SECVON
FlI,1IiR4n591_fil YtiiltBECItiON � nlrrllmall(y,CrnundlsnterSection, 1616Mall Setvlcedrutftrl !Weigh, u1/2n111
))6nn.16)61'I,nuc No.1919)111.1111, tcIlhln 311 tiny!.
Li
rrt :J

274596
tlollh Cm tinn - Drpalhncnl of lillvllutllllcnl nod Holum
ELL CON I HAG -ion (IN invi IUAL) NANI F, IP,lul)
w ELL CUN I ILACI On CUDIrANv NAPIF.
SIA I E ssIt.1. Curls I nut! wry I'EIINil le_—
II n licnllc
I
WELL CONSTRUCTION Ill CUi:.J
Itenooicei - U{vlstat of Wale! Quality - Gi ouud wnlcr S_cliuu
centirlcnv"N e.2�10��
ASSUCIAI rl1 AV() PEIIhll 1I/
lif nulllicnblc)
AApplicableL; )' !r,c.i,Irulinl IU_bluuiclpnl/Public LI li;diisliinl U Agricullutnl
wr•LI, USE (Cl:rr..6
t.Iouilolillg U I(cco:el)• LI Ileal Pump \Vnlct In)
2, \P.LI, LUCAI ION:
Count)
NcnicdI own: - --
fit--_ -1V y_
u I Iln„ne, tLnnirt r., c+',"� "nJrv, Sn4Ji vielon, 1.,1 Nn., 71p Cod?)
3. OWNER:
A Idicss
(Surd of lP(o�ole lin)
Slnle Zlp Cole
City m loon
ection 1 I Ulber U If Ulhcr, List Use
1 'lo1,„6,! ltidl,nml selling
Llltidge I_ISlopc LI V n1cy UI"In!
(cllrrk nrgn,gnlele Lm.l
Lnllludeluugilutle of well locnliun
Alt! tnIr- I'Lrnr nu, to
. 1. DAI.Ui(II.LI'.U�-(G-Q- ---
5. 10rm. I lil'fll•� �--------
6. DOES W ELI, REPLACE AXIS IINU WEI.L7 YIiS UI
7. S I Al IC tVA FER LEVEL liclutV"lop tuge"rof CAris ri'nr nt
A. WI' UI" CASING IS _ _k _. El. Abnvr I.nnd Suture?
• Irr• n1 r.fln[ ir, n,u•.lit Ivor b,lnn Loll n„lore trio!. r. •
,nlurtc ln•rrnrr6 irte nIlli 15 p11s 1A11ON UInl 1:S1 (` p
IU. \VA1Ell ZONES (iIrplll):
�,1 - -CSC
11. 1)ISINELC1-IUN:l)pcYSLJ VA�nll IIdd-.
11. CASINO: I)inumicr of Welp,1 UPI. Alnlrlinl
hrpll, I ,5_1201
fool, ln---I1.— _
[iron I o___
Dr Ill hlnl 1, I -r
I1. holft L: I aor rt. ✓1C�
Ilnni_ �___tn
flow_-- in — 1I.
H. SCRI.1'N• Depth
IJinnleict
l low In _ I'L_
111.
Ilolll —_ 1n-_-I1—
15. SAND/ORAVELPACK:
Depth
hull; 11,_ 1'1
Pmnl In 11.
16. It1U1ARKS:
I DO IIPPPIIY cFlttin(
colts!!l.l-n-I ION 5lANL
Slot Sire pintclinl
II1.
Sire �tnlrrinl
I IIS WEI I, W'AS \!)11' 11l
imIi1AfACUI'Y0E1
—
au It1=_A1-IIOf It CONS
U. f PI SSC;IO;V
ndtfl
Submit Ilse uilglnnl to t�I IbLikiltfiii-�^1,atk`r-1� )`(Ltou
11(11-1636 I'Imnt Nu. 1919) 733J221, nlMilo 311 dope.
( p,crdndn,Ilyd:..,.nd,l
Lnlihi cr!�ugihule sowce:Ut)l'5IrTfnpogln pllic nrgr
)/illl.l_ItJO I,UU
Pounnliou Ucscl iplion
1)I Lill
1'ruul l o
c
O
LVUAI:IUIL SY):JS)1
Show rllteclloll n1111 tli lnuice III miles Blunt pi lcn`
Iwo S ale hoods or County Enrols. IncludEslle tin
numb is and common tond nooks. ?
IN ACCORDANCE WI IlI ISA IICAC 2C, WELL,
CURD HAS DEED PROVIDED 10111E WELL OWNER
5
Rix! INU7IIEWELL DAIL
ihvnttr 5ecllon, 1636 1\Iill Sepik: r'e❑ler - tti !.1:1'• NC
0W-1 REV. UJ21101

11'ELL C;UNS 1'1tUC'EAUN lU:,C0i::;
No!Ili Gntolion - DCp1I Wmnt of linvhuIunent nod Nototal Resou's Divisionof Wok! Owllily - (f,Po orkif OrrKI Suction Cl
is ELLCIIN I IUCIIIII IINIIII'IIIUAMNAntE (plug ( ry� p�-� LQ�1�1
r�C< Ccr�� nG ,1A >�
w FAA,arN IIIACIVII cOMrANT NAME 1'110NY..I01ASSVCIni eV Iv() rEnntltr
51nIF, %rI,I, CIRISrItnl'IIUN fF,llnllI ___-- ifnrdlcnblc
if a dicnl'lc
i. \VELI. USIE (Ord( Applicnblc Ilan): Ilcsirlroiinl Ifluuiclpnl/Public U Iudusi1inl LI Aglicullwnl U
Montioliug U ItecovcIy LI I Ica' l'uugt \Vnlei !id cctiuu U (Mier U If Ulller, List Use
-I opogrn!rhic/Lood rrltiug
2. \t'EL st Irmo IUN �" ulge I.ISlopr I IVnllry UI'Int
__ Comity � vl ,. _ F.
NCnlcrl Irmo 1 "_'(A(li\ _ - - (tiro! nrrlrgnhte tin!)
(1J�LI��- - ��C��-, C� - - Lnlltuddluu nude of well lucnlion
r..l..l:vl.lnn LnNn,7.1pCwIr� ��p�W�3'.°. J',��-
rnISS':O -
�. tWNER•
Adders
,t"
($floc' nt r,.,::.-... ?
M .b
Stnie
City ut Irian
EIom to
nhC"ar " lv0/ (
)-
A trn cod? Plume nnmba
. d. PAIL DIM L1 EI7_6 n —
5. 1UuALI)El'IIC__(o_S ------
6. IMPS \VIILL REPLACE L•.XIS IINO WR1.1,7 Y133 U_IU i >I-
7. SrAIIC WA 1 Elt LEVEL Ilclol`U'c,1'r'' U ALor mlr i•np ni C01/e)
P. _ --. - _ 1- 1. Abovr '.nod Sin Ince'
T or (Jr CASIN(i IS _ 1- . •
'lap al r•iL4 lrnminded slim Lrinn furl n01l•on rtwill to
%11111/1(f(rioral,Lnrrrintl`itt N1E11101111E1ES 2--
10. \VA 1 tilt ZONES (drpol): _--------
.al tc A `� (7P1\{-(-S Amount _ i5�
I I. UISINI PCIION:'I)l Vinll lnt _ IS.
-
❑uolbcu nod common rood unnlcs. W o
12. CASINO: Dinn¢Ier a1 WrigbVl4, irinlctinl -
/� !kWh I inr 1, (lift,
proof-yl-_ In_1-tl__FL - -u T
flalll la_ fl._-
I I(lIII_ I n_.-It. —._.-
Mow
Mnletinl Method
I1. MUrplh r
Iloln 0 'fr'�z �L hl
How_ 1".—I1. --- -
Uinnml❑ Slot Size Mnletinl
HUH' - -- — ill.
flmlll____l_.
o____.-II__ II!.
15. SANU/UIIAVEl, IACK
Drpth Sire htnlulnl
Mom_ 10_ El.
.Lr Il. -------
how —
274595
(drRIrr✓mLnttr ✓t -nod,)
Lt litudjhopilude sun' cc:l(I II'S _I,I (limp,' npllic trio
4liUI.UNllI-UU
onl Ilion l!csyi !Wiwi
Q ; —
ca
16. IlrMAItKS: —
I Ut) IIPRFU). CER
COINS WWI IONS PAN
I`I I' 1111S WELT, WAS CUINS 1 ftl(i
9AI I S,AtdUIiIW AWit YOE 1
CON
ASHEVILLE REGIONAL OFFICE
Fubnlll the ollglnnl to the Division of \Vnlrr tpinflty, Graf
17611n-I616 I'hnnr No. t919) 7)).3111, within 311 tiny,.
LUCAIJUN $Y111S)l n
Show tlilcdlnn nwl dislnnce In miles Gonr.n Ien
Iwo Stale Enroll or County Roods. Includcn
e
yVlt S4\
D IN ACCORDANCE WI III I SA IICAC 2C, Vr ELL
IECORU IIAS BEEN EROVIUEU10111E WELL OWNER
111UC11N0"IIIE WLILL DAIf.
litire ;tier Secllon, 1636 Mill Service Center It Idgli,V. NC
01
LC /
e

WELL CONS IKuCa IUN ►ttkOlU:
iJorlli Cntolino - Ucpathocut of liuviluulnenl mid Nntulnl llenuuuc cn - Divi` uttt of \Valet ()utility C1 om'dwntt r S Section
,n rob CON TRACI Olt (n4I,I,'IIWAL) NAME (rho (rAI p'�-2- j�
,v F, I,1.CON1 RAC! onCOnIrAN I' NAMEASSVCIA'I Eli w•ry rr1U11U
SIAIE wF1.1 CONS time' ION fF.IUIIIr Ifni'limbic
if n die nick
1. Wit I1, USE (Check Applicnlrle Pox): Itesidenlial 1' hluniclpnl/I'utrlic LI ludusllinl F1 Agiicultulnl U
plouilei big U RE-covety LI Ilcat Pump 1Vnlcl In;cclion U Odic( LI It Wier, Llst the
'fopng1npliidl,mil selling
2. R'EtesCIo COCA URidge 1_Islnpc 1_lVnllcy UIIInI
Cuuitly�
NcnlcSII oa'IR_ 1�� - — frlr<r4 nppnq,i lair hn+l
Aida �{ � / Lnllluddlullgitudc of well location
(Sheet�-��-- '- ha.. Ibdi.i Ion, tui No., Zlp Code) gl�•,OR �I
fCbaiNn�ne,thrwbaa,C.•...-. N`.`a :V")• f--}W--
(JrgrreJrulnninI)-^^n,19
Lnliiud:intiu11111de Soul Ce:1cl l' It_Ii opoginpIIic oil;
tll11111 1)1t11.1,111U 1,0_9
hlalll -Ianati
Eaon )csciipliun
a spa 1�
). U\fNI�.IL
Addle5S 1J �� k-�C-\'V
(Slicer ni Rook 110.) n n
c;y pi lou,i sale
(_i'- )"
A,ra adr. !Awn< ninnbet �O 12. _
. A. DA I E DRILLE.D�Ct a3---
5. 1 U MAL Ina' 111:_�4 __-------
6. I)UPS wi•.LL REPLACE Rxls Iwo W Fl.1a YES u Nu L10-
7. S IAl IC \VA FEIt LEVEL Below 'hip of Casing: _fft____-_
(()ie"I" If Abnvr 'tor n1 Cming)
E I. Above I.nnd Suilhee•
• Ivp rl 1,. a Iran L, derl •Ilvr In NOn C 3I nn licr rrgnL ra
•
,ulintr In inflout<n111, ISA NUMIC.ellll. jj -- <_
O. Y11'.LD (rim*__t.._.. _h1t iiiuDUI' IIiS1 1� — ____ _____..��.�-
nl. \VA I ER. ZONES (depth): 1,U(:M iUti _ % ry !::
,\I�'' Shaw dirccllou nud dislmicc In milts Gaml Ic�,, Ard _/ — `wo Stale Roads ar Cauoty Roads. Inclu'Fe�'t. Ile 1,11. ii CSINII'.CIION:I)pchth�uPit \Vaillhirkncse I -12. CASINO umbels mid colnluun lond unutcs. •• n
I Irp11�
Uimuelc, or \VripbVEl. hlnlet inl U1 C:
I't n n t_Q_ .
to i El. 6o as_ S1Y� -p �---- 3ctnd1 W z
—11. GAP AL
I'imn_ la._ - '.—__-- ___. _— Lirlhud �.
Dr,lh !Aril 1 nl -,
I1. Cilum_ _. I
Ilnui �I't.. -- — A
t" — 9
14. SCRIiFri! Perils Uimncic, SlulSim hlnlclinl
N
in. in. ___
II _ *l o____ _ 11.
in. hi.
15. SAND/GRAVEL PACK: hlnlctlnl
DepthSize
ruin' -in__fl._
Rent lo= Ft.
zip code
274592
G(
DII[ I.f,crtAl J
IN) IIIIREl1Y LERIIFV II
CU11511tUCIION SfAFID I�
W
IIS Wig 1, WAS CUIIS I IItICI EN 111 AC( ORDANCII WI111 I5A IICAC 2C, wEI,L
AND MAT A COPY UE'11115 RECORD IIAS UEEN PROVIDED lO VIE WELL OWNER
$ICiNAIUI(RUf 11E1(5Ut4CUIJS116:1INO111EWELL SAIL'
G501' n A`E . SECTION
A 'N f F r {='lFi,4al`1FrfiiiEp Div Inn ni Wn(rl Qunitly', Groundwater Section, 1636 Mall Service Crider- REV. tlt7ric
id901 36li R
y7f.nn-16J6 limit No. (919)1J1.1ill, wllhtn 311 days.

274591
WELL CUNS1'1tUC1'1UN ILECiii:"
NoilliCuloliin-DepathncntofEndionntcutnodNnlutnlItenoulccn-D1lvvlsluuofWntct Quality -CJEnl11fIGIrudivnIcr S .tioII Obi
g
\I ELL C(1NIMC'1 11I1(1N 1111'I ItUAI,)NAnI F, lPrinrUl 1(Jy 111 �� _ ` \� \ •� r110N P, II(�
l ✓ Q
WELT CON IRAC! U 11CUM PAN I' /\gSOCIAI Vil\S'Q rr.Ilnll 11 �--
SrniF. \(ELL CONS IIIUCIIUN 1'EIthIllnl51ll►_--- if n t Jicnblc
it n l !kid c
I, \V EI.I, USE (Chrrk Applicable Pox): Itenidculinl k Municipal/1'ulrlic U hiiusllinl LI Agticullulnl U
Monileliug U Ilccor'cty LI Heal fungi \Vnlct Injection LI Oilier U If Ulltcr. Llsl Usc
1 i ,N• 'hginglnlrllidl,ntlll •:egging
1 ':ngn15'�YiY_S_.t.;lill =. Lididgo 1_lSlopc i-IVnIky
"% \�_ Irhfrk nlgnrgninlr brig)
Ncmrsllowu��7ld��
Ulint
Ge�n.�.r_U_L,.—_ .. _ _ _-.-_---- — — LnlltuJdlvugiWde of well Iucahug
--Urel flame, Nnudar., i:ecs^••dro, Subdivision, bpi Iln., 71p G.le) 1& n+l 1. I�� L,!_ r _, S-
I5 1 L s�
3. p\tNEI 1 C \i\Qllit
----—
(drpreJmLnnrid rn rl•i
AdJlcssr0-5L— - >s ODLLnliiue!!1ngilude soutcc:31121I'Sf1Tnpnp;p le n:1f
ISIffnl Route lint )LLlll (check ir•;
)/RI1,11Pi I,UII
horn To Eolmniion IJcsctipliun
C
71p Code
Cigym�on SIn1e
Mr• ride I'Imne n1 t I1n1 �� ��
S. DAI h 171Cii.Li U --
5.-IUTAI.NIP IIL_
(. NURS WELL RE.I'LACII EXIS 1 INN WELL? 7 YES SLi
NO IU-
7. SfAIIC\VATC•Ill.IiVELUCIVl,C1oI'rtaCitcaf1ornlc+•nal
I' 1'. Abavr I.mul Sullnce
R. 10lrl'l'AS CASINO IS "-�_-_--
• 1 rP rl r•1irL bnnn�•g r,l dirt hrla” Imd rim butt wining
IC
•ubnrr Inmet rl•hrt nllh IS'hll?II(IUD UlA•f l;$I
O. YIIII.11 (nimbi % _
I U. WA Ell LONIIS (drp110: —"
AIn111n11
• `;INfI'CiION'�I)I'� ,Il
11. IlI
. Wnll'lldcknc+s
12. CASINO! llrplh Uinincicr or \\'ripIIVI'1. ilnlydlnl
1.10111_S2—.in_Lr[--a__ I:t _________
-
1'lout_ .1,_ _ I L_—__. Melhod
Ile dl1 hlntke
I1. OROUf: I 1 1'1. �C�v�_ C
IlOni Q_ i0—ice
I10n1_"___ 10- IA __ 14. SCu...i[ I' ptnlcginl
I N: ',gill' Dlnuilelel Slot Sim
In.
How. - _._ 11 _in. In.
.I.n -
hmn--_--. --
Ill in.
15. SAND/ I AVE1, PACK: hlnicllnl
Depth Sire
flow_
to 11.
fllo__—it. --- —
mn_
S•
U\',� i
1I'\'-tII
DNS WWI ION S'AND )
GAOUNO\VATEP SEC;i{ N1,• in•
A$`IEv�hUE1RFE�jrr'4!N6�ki, .
17f1 -I616 Inl11
CAI 0
U1ISKELc)I 1 3'-,
l,tlC61.1 .
Slow di!ccllnn nod dislnncc hi miles lion n lcni-�c
Iwo Singe Runts of Comity Ilundl. Iticlude roalj
timid/cis ntnl common mad in4ies. _ r- N-ra
1 `' �4 L / C.11 6.CZ E
-tC
c -Top R:
IS Wili 1, WAS CUNS I ItWICI E.D IN ACCORDANCE WI Il I I 5A I ICAC 2C, WELL
ND ItlAr A COI'Y UP MIS RECORD IIAS BEEN PROVIDED 10111E WELL OWNER
IUtIAIUlll! VI' I'E.ItSUt1 CONS7IlUCl11101IIE WL'LL - DA11.
„tic n.1..111•• Cs .,tirlwnlrr Socllnu; If16 Mill Sri -vice Ceder - IInleIRl1, NC
r it ai \1n •il n-- UW-I REV. 9712091

W'.LLL CUNS1'1nUC'1'1ON 1U�Ci;:::1
1Jeith Cnlolina - Ucpaiuncot of Iiiivliollillent and Nntulal ltesoulccs - Division of \Vnlct Qualify - dFo iid nlAIrIS ioui 4
ll II If
t(r.I,I,C(ON I ItACI Vll 11N1r11'11r11 A1.) NAME (pint) ��{ j�J CIi11 It /1r` ( 1Yl rtIUN IC II Ot
1Vr.1,1. curl I RACI WI COMPANY NAME Y 1'1F.IlR11U
51 A I 1crl.1, CONSrIliIC1 ION ftltMIl1 _— ilnrrASSVCIAI P,Ir l l 1Y(
IP
it n i ilk ntrlc cable
I. I' able II 5). Rcridrnlinl 111/hllnliclpnl/I'ulrlic U Iudusllinl 11.1
2. R'ELLLOLAI )t� d:
Ncmcst Iolvll:_ ,.1. Ir--� Cuuulycnb. 'k4D-
fleet 11nmq lhnnhe •, 7 : ''.hv, SnLJivielun, Lot Il ., 71p Cody)
3. OWIIFlt
Adtlicss ly- �3_—�'nG--'---
lsnrcl of Route 110)
1�-Dorta,h- /v
City lotto 51n1e 71p toile
1V1!Ll, USE (Chcrk App Icn r c n.
Mmiiloliug U Itrcovc,y LI Heal Pomp \Voter infection LI UIIIer LI()duct,l If ()duct, LIs1 Use
'fopogtnpliidl-nlid wiling
Ullidge LISIo1ir I{)' IIcy UI'Inl
lchnrk npr olollle boil)
LnlhUddlollgilude of well location
Air) tr.ir. I Zone mmil-a _
. ,I. 1A I N DIIILLED
5. l 0 FAI. DEI' III •_i_0.6 '__-----------
6. IIUIES W ELI, R.EI'I.ACR. EAI S IINU WELL/ YESCl NOAli-
7. S rAI IC 1VA I ER LEVEL Ilclow.1 op of Casing:
iIn___IDr-- a1
4.
Oyu."
fl. -I O1' OF CASINO IS __--`__" I.. F. Above I.nnd nth lhce•
• Irp rf r•d,q In ododril •lrrr btlo" 1•o l ',nine Iriplrn •
••moat In •rtritlrittt nllli I5A NUC lC.n1111. FAA_
/� n1Ii l l IUD UE 1IIS f4 -
V. 1'II°I 11 (fI'ul): _ADD- --
10. WA I Ell TUNES (drplli)):�—�}7�(��,{�$
X - "— A1I11111I1i __ — Show direction n111I lh9in'ice in miles limn lclmnf�
au l vi Stole Ronda oI GIlllld Ronde. hiclud`3
II. I1ISIPJI"pCIIOrJ:'fypc Wall IlJckncap
12. CASINO: um !bets and common rood names. v z
/Uimucic, (n NcighVFl. Llnlciinl
f ciSO t f LS ".) S �_2S2l- .- .�L�—
I'ioul
now lb fl.-
how_ 'fo _ h1._
he dh Mntclinl Method
I). NUM F: I (� c
fol'- TO_ .I'1._
llinolclei Slot Site Mnlelinl
in H. SCpla°N• I1Clilll In.
inin.f Afll___.—_..I-o---- I I.
IS. SANDIURAVFLPACK:
Depth Sire
floor lb El.
Rum fo
274588
Agricullmal U
61rptretit nutrJt ccnndQ
Lnliiudc• !niivitude smucc:Utll' SUropoglaphlc tit ip
Idled boy)
PE tll 1/IU1.I,11JU I UU
l-�,I -fo Emulation Description
I
zilLn
e
I lilth
El.
I 3IC110115fANDARDS, A
J
GROUNDWATER ggE UO of
IbndA$IIIEVIL41L'4t041Dia OY PGtII
Metellnl
1
cd
, - et
W J
I,V ATIUD 1'U. II
17
, WAS CONS I It(ICI I'D RI ACCORDANCE WI I II I5A NCAC 2C, WEI.1,
1- A GUI'Y 'I IIIS RECORD IIAS DEED I'IIUVIDEU -10111E WELL OWNER
lu! Ur I'EIISUN CONS IRUCIINUIIIE WELL DA1I,
Vnlrr Qunlfly, Cr oundwwnler Section, 1636 Mall Service Centerl !Weigh, N )01
h1 311 dnys.
(-n
w
n
116911-1616 Phone No.19

Z_ WELL LUCA11UN: Cvunly
NQcnlcsl 1 owu:M! \ ----
lrCI } Ili--- ei', t. llv Subdivision, lid No, 7..1p Ciwlr)
ISbrrl HA!. Ilun�bel •, C•,�......
1. OWIISI11-1 —CIMD--- — Ln!iiud;ru L,RiluJm csoceCl(lI'SI_lfnpoglnpbicm=p
nJJIcsS 4".6-��Icl¢ck!en;
(Surd of nynne llo-) Mini (1JU1,!,(NU LUU
lf _ 5. 11e �I / U�--- froul to lot !Whin Ucscliplion
- -� slnle 71p Code - `
Cil)� tit lot n
Nrr throe IL aid mm�bt' �O� (- a/�K
4.• nnrrii : altoMLru L!- —
--- —
6. NOES vvELL RLPLACI, EXISIIN0 WELL! YES U NO lJ-
�—
7. SfAlICNAFEE LEVEL llclo+`llcrItA
rptr!nvr'60 I I,
IopolCn,lnc)
CASINO IS 1 LI -. Above I.mnl Sul nice. .- o
•Ire tc.r Lglennhal nl It I5 brio. U11.lend nnL. Itquh rr• --
intent! In rrrniJtiitt n llu l$A NCAC JC.nrlR. _---�n
h11iI THUD OE .1 t SI.____ -- __ _
III. WA I lilt LViJF.3 �^{•Ih): -- "- (!;•(;I lt_lIJ SYISIL)l tV
Shim (itccllun and distance in miles lion nl Ica ':_;
+( .� 1�4 5 njpp°ii1 - - le I(unJs or Cooly Ronda. Includ a lrim%
II. WSW,. IUIJ:'f)hc Wnll lhickncsa = i
12. CASINO: ❑uurbct. null cuu;;:to fond mow! _. r -�
„ a
l trplll Uimucicr m 1VcigbVl9. Uhlnlrlinl 4" ell 0_
t.J 5
Z
274587
11'ELL Cl1NS'I"1lUC'I'IUN Iti l:iii:1)
ljuitll Cnlolina - Ucpatln¢nl of Iiuvllotuncul nua'' Nnlurd Itenoutcc - Ulvl\uo Sly t ()wilily -CI`o nilwnlor ill IF ICA Ir S ► �I DU
t"')
Is ELL CON IMCinn l lNUll'INII AL)NAnr F, Ip, l G ryF 11\ rIIUNP, a (v"') ���- 2q�?`I
IS U,l. CON 11UCIOn C(1 nIfANY NAn1 F, J
ASSVCIA-I e.11 \Vt) 1•7..101I 11t
SIAtF, tcELL C NNSIIIUCIIl1N I'F.Ilh11U__-- iI n I dicnblc
ifn�diulidc
I. WELL USE (Chrrk Applicable Pox): ItesiJculinl I1f—NLnliclpnl/public U Indust'inl LI Agticullulnl U
hlpnilvtiug U Itcclt'el)' LI iical fungi \Vole! infection LI (filler LI If Oilier, List Usc
•fvpogi npliic/I,nud selling
UI(IJge 111a111opr UVnllcy UI'Inl
(I,rrk npprr,pll,lr I n!
I nliluJc/Iougi!udc of well lucn!ion
1VJ5; of 11 _etl�
(drprre ndmnrt/s-^n h)
1lnn�_ 1o�_pl.�— P( �-- a7-
non, 1 o rt.— t
0 Il.-- --. —_-_ J.r
I'mul Method
Nigh hlnlcj ;n
I1. NUM I'. I �/
flvn,_ _ To d2b El.G
from___--rn_.—E1_------------ .—
UimntIct Slot Site h,nie'inl
in H. $CI'.IP1 !J Ucldll in. _ r
To-_ _— It now__ _--. 3
15. SANU/OIIAVit, PACK:
Nth Sire hfnlnlnl
Iwo' .I o—_ !l.
Io El
--
!"lino
16. REMARKS: I�u�n�®tn�n OS 1 MIIIS )VI II,IAh F VAACSOGPUYNOS II' IUMIU_ISI i_tEE)CIOIJ WnCICA0_1StuAnNltC
n
cl
r
N‘ V t w2
t>
v\S
o
e
id
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hoc
sF
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IA
tVUlVllIlUILS
Un
l1UC
1A
1C
CW,
I L/??-O S1.LLUI-UI,WIEt
-
t J�( 1�°IONAIUIII!UPI'ERSONCONSIItbalik1"IIIEAvE'LL !)AIL
- 3 2003
ISublull lilt orlpinnl In Ili I)Ivl len of \Vnlrr Qunitly, CIounJlvnler Section, 106 Mali Service Center
REV. rlc01
Atily�j�ld i1 o'Nftt'nT N9 1JJ :"I' "III"
JII Joys.
A H VIL oIOP;AL OFIC�
a 1, e/(

WELL CUNS I'IIUCfIUN IU _Aii(:?
Notili Cmolina - Wpm Uncurl of I;uvLomneri( nod PIuIuI:J IlenoIIICC - +IDivision of Writer Quality CI�Nt11ud sr flier
A. Ily + �I ioII
'ELL CN I RACI UIt IINtIVINUAL) NAME (piint)� tAT✓1
_r11UNr • IXu{7%��1
Lag--- m ELl, CON I RAC' VIA COMEANY NAME �—
si A I E ME IA, CONS IIl11Cl ION rEItnIIIA _-- ASSUCIAI VD Wf) r r1011111 — if nlrlicnblc
I' I I II Residential Iyr 111111cipnl/Public LI InJustlinl ILAgiicullutal U
WELL USE (Check App Ica r c thirty
.
Moniiol ing U Ilccovely U Ilea( frump Writer injection LI U16cr U If Ullicr, List We
fopoginplridLnorl selling
2. N' lr5l 1 CAilUN: h _ Coullly ,"I(�p Ullitigc USlvpc UVnllry Ul lel
NcmcAl �I oa'Ii: ��_^� \�� — ��-""' (clerk npptr,prInlr hn•)
lop . �JI _- z/- ° /� Latitude/longitude of well location
ISbeel Name, Nnmhul, Cy....... hr. Subdidslun, LP] No., Zip Calr) 1 1q Wt''-i : . rL
r (drprreJJnnlydr—^ndQ
1. Il\\'f7ER:1 --1 `� — Lnliiu Ldl•,neiluJc soutcc:U(11'Sfl Follogl opllic toll
Addlcc5 F (check box)
' ��L.-_— Cl� E)I II-L_INU L.JC)
ISmrel m Route Ih,1 l�(�1
����-___--ip 1 — 10 folmnlimiUcsclipliun
Gill. n�„�s�nle Zip Cole
LL2 0 - 4_.S`
274586
Air, rr.ir-floor numb❑
5. -1OFAL IAIil' III:_ b-.--------
6. IMPS WELL IU?rLACE EXIS IINU WELL/ YES U NU I Ll
7. 5IA1 IC \VA1-Ell LEVEL ['rimy 'lop B�
r.
If A! o r I vo „t Cnhh,A)
R. 1 UP Uf CASINO IS _._--- I.I. Abmvr Loud Sutliree'
•I rp rl nrnq i,t' minded &lin Inln,+ Ln,I nnbee trinket II
1nl.ncr In •rcm119110 nllh IRA NCAC 7C UI IA.
ME111UU UE'I r
I(LWAIEIlZONES (drpth): ________ --
+u Amount _ l S
11. I)ISINhE.CIION: Fypr
\Will 'thickness
IL CASINO: Diameter or \VeigIIVFl. Material
hrplll ����
from F1.
hint .1n _ - _ _ __
hmn_ I n_It Medan'
_Dee uLa I1. URUUI0____
•� Depth��Ifi✓i�
from S� .�fe
prom
Diameter Slut Sire
El 1-0. SCREED.thrallIII.
IIoltl_-_ _ _. TV_ ___ I. in.
15. SAN IJIURAVE1, PACK: Sire
WirthIv
R,j tECAItI~S:
AI IIEIIEUY CFRI!Frill
NS1l CIIUtiSl2i j All
I' t.
Mnlrilnl
Mnietint
LULAVIVN_SKEJCII -n
SI I Ilou nod dinlm,cc 11 males Gum itleastr a
olv
1I1 C
wo Slnle limits or Courtly Roark. Include r loam
tunrbcls mid cuuunou lend names. CO i
WE I WAS CONS I RUC! RD RI ACCORDANCE WI I I I5A I ICAO 2C, WELL
D'I IIA f A COPY 0I' 1111S RECORD IIAS HEED I'IIUVIDED 1 U 111E WELL OWNER
y�OZ
SI t1A1 tJIUt OF I'EICSUN CUNS1 RUCI INU 111E WELL DM F,
ROUNDWATER SECTION-
ASHEVIL E RE" I'ANA 0 FIG 111I(\\'nlrI (lunllty, Cramid water Sectlou, 16J6 Mall Service Culler- liLV RD'7200I
176oa-16J6 Phone Nu. (919) 733-37 I, al Willi 311 tiny s.

274437
WELL CONSTRUCTION RECORD
Ilnlpl 1 :nobs'; - 1 )c11:111111l nl of I!nviroumcnl and Natural Itcsnulccs - Division ill Winn On;dily - Oruundwalcr Sculion y
CEII I %FICA! ION N 32 -J
inn llNuf\'IUIInllrvnnl P. WringWring1AAAA�.v1� N._ lV_1 OTH rZ r7�f`O.L�+` 1� r11 (/9 _ I'l11)Nr /I 1�S)33-7"'81
.
�.
will Iu�Yln\l lull l'u11 I',\N1'NADII'. _.. �^Q.RD�QQ. �1L._VF� .Ja _ ._
1\II oI.1I.(DV;IItl('110N 1'E1011 Itl — -. _. ASSU('In'Iil)\\-I) 1'f.I111110—
(iF:11p1ic:Iblc)
nil❑�,1ic161c1
I \\ I 1 1. 11'd. 1(-In•(1, Applicable Itnx): Itesidenli:d Nluulcipal/I'uhlic Cl Inllnsn ial ❑ Ainicnllutal U
G Union imp. I -I I?crl'(cly U Ileat Pomp Walct Injection U Oilier ❑ 10 111ei. 1 fkc
V1 1 1 1. 1 I n' /A 1 I 1111 I, ``
11,•an �l 11nu1 eltl? iadiQ\,±.
PUETT _C o J C=7
.._
slum brl<. 1 1•n nnnoily, Solon vision, lot No., Zip (odcl
Albs[.; P o_-.. Box
ir
t II\\111,11
ICII •, l 1 aoule Plo )
('ode
Ccl� Tp
( I jr>z I $G> .5
..,r iir: h,o:•nn:l..l
i II'IFI 1:1)Pr II I \I I"ITII I' 5 1_L� __
( HMI )I\vFII. RillAi'F I (XISI-INU wi tt 1:? YFS[1 N() ur
7. S I A \\'A ill" R.f.\'I'.I. llelu\v Fop Jp0. _..1T.
(Ike it Alm%e '1'np of Cn�in al
F 'I1+1' Ill 1'ASINil 1 IS _ I -I. Abncc Land Sullarc•
' I,q, of r:nlap leaaunt l,rlao Imnl airfare rrqulrn •
.:nia nrr In :i n il:my. nit!) I5.\ N('AI' SC.III IN.
n } II'I.1) lupus) - r _ METI I(7I) OF IIiST A:(/?- .._
III \1A I I!It II )IJCS ldcplll)
11 1'1'4141 I ( HUFF 1 ;1 Cit•l�JR1 Anlminl..../C Lit
I7 l -:\SIN! ;. \V8Il lhickncss
Rik!. U//..kmeirr or Weiiglll/I'I. Nlf:,lci;d
11nu1-- 3 In_/3/ 1-1_1p _ k1p2. I-_.1:_i''L
Et
I loin 1, _-_- I't.__
1 1ni 1 10 _.. 11._
11 1181 llll' 1)1.111 Nlalclial �Nlrtln:d
I Ion. -. C� - 111 . Dck fl.i��^tP_`--'T-- - /_W Via
1 win ',7C in/r3./_ It .[' L4%7-b_ty S_.
P.IIN'. Ucptll Ili,n,eIcl Slul Si,e Melcli
I inns
nnu 1,' 11 .__ ill 111
';AI11 )'1 iItAVI'I 1':\I
11.1.11.
111.111_ t (,
111,111 11,
Jr.1 \ I=
I In1111111h 111 II
( nN..11/L111 111 /11 1
•
(FOUND% tilt
`I 1�
FSn[VIL 1 FIGF )iciclnn of AVain Quality, Gtoundnalti Sc01°11. 1Gtg Mull Remo• ('color- Italrl) L, N('
I'oq'I I b 41 1'h:alr No 1'I17) 7 t 1. 1221, a ilhiu 311 da)s. (iW-I Itl'.V. 117/2111)1
Size 1\I:1111i:11
1-1
Ilq,ngrnldlic/I.mnl selling
1V tilitne C]Slolle CUVallcy ❑Plan
I rIra nor' pre nlc luixj
11ilndc/Il'Il iIadc of Wei IOC:01011
1,1'�1 I oolr[�[r,nll[)
I :IIiiaJc lnnl•ilnll _ I ml ca J(il'S(I [ (pogrgdlit map
Iile(1 boss
111'1' 111 DRILL ING LOG
Ilnm In 1'n'nlaliou Ucscripliou
Cris
—ea.
;r
lIRAI-ION_SKlil:Cll
Sho\c lib"(lino and (liclancc in miles fiow,}•d Ic h
I (vo Sl:dc Ib,a J. nl ('ounh Roads. Inclu(Jclhc IRA
numl)e I'::llld (0111111011 road il:lllles. `—". n77..)
W o
I IIAI 1111S WI'.1.1 \\AS (i)NSIRI I( 11'U IN AC(UI11);\10 I. \1I111 I5A NI'A(' 2C. Mil,
\ItOS./1Nf)'IIIAFAcopy S11) Inc pi l)tt AS111'fill'11M'II)I1) ID111LWELL OWNER
c<ti 5 —o3
FItS
I'I�ItS\
UP .UN GUNS !Roc IN(i I I If \\I1I. UA1Ii
IGNAT

272703
WELL CONSTRUCTION RECORD
Nmlb C:oolioa - I )cp:n lmcnl of linvir nuncul and Natural Resources - Division of Water Quality
IIIIrI,INntACnnl(INntVlnIAL)NArII (print)y!-7VJ1> E/21Cl•W'1-)0h-)
IIIt ( Ildll`ANI' WOW,r %'LQizoVea• I I 'gii_ vo
S I .\ 11: 11'I'LI. ( I ltl'1 I ION 1'EDNIITN ASSOCIA'I rll \VO 111:It M1I N
l if applicable) (if applicable)
I. WI-I.I, I ISI( (Check Applicable Ilox): Residential /Nltulicip:l/Pahlic ❑ Industrial ❑ Agricultural ❑
Ntmilol ing❑ Rcancry ❑ Ileal l'uulp Water Injection 011ier Cl Ifl)Ilicr. l.isl Ilse
- Groundwater Seclion
CEn rIrIcA'IlON N . '/ ^/ -/C
1 \\I'I.I.U1CA1ION.
Neatest I owm. �}'( U County.
IOC) lb AC '
t dt, Nance. NuntbrW.11oannoily, Subdivision, Lot Nn., Zip Code) t
//��//�� )' 6)“.... 5/t-ve+e.'
1 OWNTIt' /'J E'��j M ('UN - Grof (dcp¢eWuinulcs/seconds)
\dJt ess � 5 % 511 eS Rn I.:ditodcllnngitudc soulcc:❑(,l'SCITopograpItic Map
(check host
DRILLING LOU
forncdion Description
'I opogra a is/Land selling
❑Ridge [Voile ❑Valley ❑Plnl
(check appngn tale hos)
I.at ilu(Idloogiludc of well location
MIcnr„t„unnCll [ 1G'
Cih�
� w Slnlc Zip Code
n c:nlr Plume nitd.ct
1)AIt WILLED
6 I)n1'S 11'P.LI. Rli.l'I ACV. EXISTING WELL? YES ❑ NO
7. SIVIR IA'A'12(12 LEVELBelow Top ofCasing:
(Ilse "I" IF Above 1 op or Car inol
g. 1 (11' Of ('ASINI i IS / ET. Above band Surface°
(log or color( trt nli aunrd al/or below Intl mrrnce tetwIret a
I:olater In anon dmtsc II lilt I5A NC AC 2C .at IN.
o. 1'll'.I,Dlpl11"1 ate.... --MI IIIODT OI''TES
In A1'�11!RLONIIS(ricplh): / 7c I
1 / 2- g
2,-i/-o3
5. DO AI DIEPrn: 30.5'
I I. I IISINI-FCIION'. l)pc(".it]_t.Y-211.3t- Amount [_Cld%
12. LASING. Wall•thickness
Ueplli Dianlcicrr or Wciglil/fl. Material
1 ion � To Qli il. (j)/5•c ShC D-i P Ci
hoar To Ft._
1)1:1'111
limn rn
1
oS) SL-NTE
Mom Tn ht.
11 (1RO)11: Depth Nlatcnial Mclhod
M, n) Atoj
I Will 0fu ��-(� I'1. ck) �
i ttno .7) Io... (/v_.._I:I CIA rn_iv /CisI a)T1j
11 S( mill I)cplh I)iantcicr Stol Si7cc/// NI:ncti
I tom__..___. lo _...._— 11. in. in.
I'tonl I i . in. in. _
I5 SANI)'(IRAVEI. PACK'
')club Sim Malcrial
I tom 11 fl.
I lone fn I1.
LOCATION SKEICII
Show dilcclion and dislancc in miles (tont al (cast
Iwo Stale Roads or County Roads. Include the road
numbers and common road names.
o 4
xs5
lu; tti NI, RI\.S ;+
I un III RF.1 l' (TRITFY lI IA IIIISWI.LI, WAS CONS IRIICI pU IN ACCORDANCE, WI I I I I5A NCAC 2C, WELL
I C(INc) I IttI( I ION SI ANI)y\IR"S, A 'II IA L A C0l'''Y0�1:1111S IttCOItD I /4 I)I TN PROVIDED T0I I IC WELL OWNER.
.1 Li
L _-- - J SIUNAIUItEOEI'ERSONC'ODISIItUCIIN(i11II(.\Vlll,l. Univ.
l�J
S E4'ihnn) the tifigii :rllt EIIu 1 ;vision of \Paler Quallly, Gruuudniter Section., 1(16 Mall Seri Ice Cruller - Raleigh, N(.
2764". IG}L Ilium. No. (I Pi) 733-1221, wItldn )II days. (iW-I IIEV. 117/2001

272702
WELL CONS'I'RUCI'ION 1tECO1tll
Nol Ili ('ainiina - 1)ep:ulmenl of Environment and Natural Rc✓:odices - Division of Water Quality - Groundwater Section
wFlr.(UN'Ili\CNMI (INlI\'I INIAI.) NAME ( Vrl"1) TAv II)1r�._PiCVIA3 0N) CERTIFICATION 11 a;
VII
NcII I. ('NNl ItAC l Olt ('U\II•AN\' NAME 1/
SIAlt:\C r:t.t.((1]SI itl'(' NON PERMII-N ASSOCIAI Cu WI) ES. (MI I n
lif applicable) (if applicable)
WIT I. NSE (( heck Applicable Box): Residential fvlimicipal/I'uhlic O Induslii;ll ❑ Agricultural O
Mauiluliog L1 Itecmcry L7 I Teat Pump Water Injection ❑ Oilier ❑ If other. List llsc
2. \VP.1.1, I.I )l'A II()IJ
N c:u est ll lwu /F1U County C110-0
DlcJeV »i 'ESrri S �i
I':urrl tenure. Ni rims. (. it lenity. Subdivision. I otNo. Zip Code)
). ( )WNIFIL T/11 hc "\
Addle 3 CosR )3[-uF)F
I`hcrituulc Na.)
/igunnL tic �B7oG I)I:J�Ijj
(-iiv ar L„� I Stair Zip CMIC 1'IUIII I n
BiFf) g37 6C177 C) — 5C T
ac:r rink Phone norohrl
1 VA I F. 012I1.1.e13 )J-a3 -03
5 "I0 FAI. DEI'III: 70() '
6. DOES WIWI. 12E1'I.ACE EXISTING WELL? YES Cl NO
7. S I Al I(' \VA"IIiR LEVEL Below Top of Casing' /L'/ ET.
(Use "a'• if Above lop of Cueing)
R. I O1' O1 CASING IS / ET. Above band Surface4
• Ina of ra.ln L' Irnuln nerd 11/nr below laud endure requires •
, nrl:o,rr h, nrcordnnrr nllb I5A NC AC 2C .III IN.
'1, } I1i1.1) 1!'I'ul) --_— MEI'I IOD OF TEST /9 )iC
10 WA EP 7,ONES Idcplb):
II. ',Ism! 1,(1ION, .1 ,,,,,__CLLte Amount L u_�__
12 CASING' Wall Thickness .
Dcpol D':un•Icr or \Vcigld/El. 'Malcrial
I roof To _ Ft.
1 tom _ To Et.
11. (;1201 i i I)rpol hlalcrial
I mnl _ 0 Tn a(..) 11. Ceme_S-
I N,n,_ u__ I, SS i 1._ C TrteJq 1.
IJ. St ILI ILL Ncl,ul Dianielcr Slot Si)c
Flom to _.. I I. in. in.
Fwin _-.. Ili Ft, in. in.
15. SANIVOIL AVM .PAC L.
1 1111)
Ifrr:1<i
is '_i lei fy
I I ❑) III :121i111' (T121 11''
(1)Nti IRI I(' I Il)N SIA
L
Pt.
F1.
Size Malcrial
Method
�pV fr�
RateS1
_55 '- ti0
I\
J
,pographic/Land setting
Ridge L)Slope [Walley 1:11:191
(check alq'I opliale box) .
I :nitride/longitude of well location
( de gr rec hni nu t rs/s re.i (1p)
L:diluddlongilude source'❑GI'SLITupogropbic map
(check hop
DRILLING LOG
Formation Description
S Ci7S ,-) 6-
I
LUCAIION SKEIGII
Show dircelio') and distance in miles from al lens)
Iwo Stale hoods or County Roads. Include the BEd
numbers and common load mules.
Dicke)/
0
0
C0
a
3
7.7
c.11
07
o,5
I' 1 I IIS WELL WAS CONS 11211(' Il'.N IN ACCOItDAN('p. WI III 15A NCAC 2C, WELL,
S, AND.' I IAT A COPY OF "I I IIS PI_ Cam) 11 MEN I'ROV II)ED 101 IIE WELL OWNER.
C21—
SI(;NAl111RE OF I'EIttSS(3N Cr)l'Jc I RIiclIN(i l I11'. \VEI.I. I)Alli
Svbluil the origiva I1W the I 'vision of W aler Quality, Groundwaler Seclluo, 1616 Mall Sen lee Ccnit•r - Raleigh, NU
)76')q 1636 I'hmrr Nu. ('I I'!) 1 {1-1221, whhin }I1days.
(iW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
Nei llt (";uoliva - I )cp;ollncnl of Environment and Natural Itcobtccs' Division of \Valet Quali
(ur
\tI:I.I.(' N"IIC\("IOIt (INDIVIDUAL) NAME (prlot) ✓9M� %c-'. ROS£
ttl•:i.L('ONi I,AC loll (-OMEANT NAME fioaa v x°k` ,�`Ihf-•L,U
si All: WIT I ( ONSI ROC ION PERISH I' ASSOCIATED WI) PERMITM
OAapplicable) OAapplic„ble)
I. WE IA. IISI. (Check Applicable Box): Residential III'/ Mtin Cip:J/Public ❑ Industrial ❑ Agricultural 0
Monilul big ❑ Rccoccry 0 Ilea„ Pump Water Injection ❑ Oilier 0 Ifl)Ihcr, List Usc
272701
ly - Groundwater Section
CF.ltTlFICATlON $ 3186
Alone a 1Y231 1/17/2-343 /
2 \VI'I.I.I.00AIION: ��
Neatest low /MU AP ky Counly LJl�Ep
4M e2 1 co 6P C
t':nrrl Nnmc. Nionbel s. r'mnlnuriity, Subdivision, Lot No.. Zip Cale)
OWNER: /oDO a- /IMP( IA Th(o,S
\ddicss _001 JItr)Der) v/4119/ C,Rci
Sj)epheP sw4W 149 �5y.Y3
lily ow no Slide
(Sheet n Iiotuc No
/ I -
Zip Code
,3014 r3 76- i/GSS
I.1
Alen coda phone number
4, DAII. DRII.I.IID )I'?q -05
5, in( At. DRI'll l: z00 ' /
6. DOPS WFLI. REPLACE EXISTING WELL7 YES 0 NO V
7. S IAIIC WATER LEVEL Below 'fop of Casing: /00 PT.
(Use "s" If Above Top of Casing)
P. 'I( )I' 01' C•ASI NO IS / PT. Above Land Surface
' I op of cioIng lerwhnlcd Woe below lend surface requires •
.:glancr In srrnrd note) Itli ISA NCAC SC .011 R.
t). YIP.I.D (rpm): Y9-i_. METI IOD OF TEST A I R
I0. \\'AIT.R ZONES (depth):
II DISINFECTION: Type l n
i1.oRmNQ
12 CASING:
Depth Dial i' nr
I tow_O Di39 _ rl.
now Tm rt.
Iron, 'In El.
11. 1 ;R1)U I : Depth Material
I Into L/ Tit �(�) rt. O2'ne`) 7'
frog„pa_ I"551 rt. C.I413±915
1 sutzEEN: Depth Diamcicr Mot Sim
fnnn To_ I'I.
'lbpogla ./Land selling
[Midge 1 .dope [Walley ❑rlal
I check npprnprintc boll
Latitude/longitude of well location
I legrecs9ninnles/eccoothl
Laliludeflongitude source:❑GI'S❑Topographic map
(slink boil
DEI' i I I pltALLING LOG
n olo To Formation Description
S-C C,9s)N6-
CCU' 5
5�' —7no'
Amount_C of
Wall Thickness
or Weight/Rl. Material
sn�1
15 SANU(il2AVM. PACK:
Dept„„
nom To
I loin To_"-_
Al.
il.
5ize
Ma(orial
614l�ti: 11
G-Anrt77F ram"
LOCA'11UN SKEICII
Show direction and dislance in utiles Ilona at lcnsl
Iwo Slalc Roads ur Comity Roads. htclnJc the road
ntl1nhc1S a1111 coD1ID011 road names. 17
-c
0<
srn
>0
rn._
con
rrfl Z=.
s
c-n
W
0
0
Z
I DO I I f l P.141' CF P. I I I \' I
it tit/SURIICI I ION S'FANI)!
GROLIL:DI P.TER SECTION
psurV, LE FE( rr
Submit the original to Ih • I)iv
27699-1616I'bnnr No.1919 711-
11S WELL WAS CONSTRUC I ED IN ACCORDANCE. WI III I5A NCAC 2C, WELI.
;f IAT A COPY O! 115 RECORD HAS BEEN PROVIDED TU l I IE WELL OWNER
28 0 3
GNATllitls OF I'lil(SON C'UN' I RUC'I IN(i'I I II'. \Vlil,l. DA"Ili
i inn DI Water Qualily, Groundwater Section, 1636 Mall ServIce (:cater - Raleigh, NC
3221, ssllhlti J0 flays. GW-I REV. 07/2001

272700
WELL CONSTRUCTION RECORD
Not lh (':unlin;l - I)cpnl(olenl of Environment and Natural Resources -/Division of Water Quality - Groundwater Section
\tt l.i. 4. pis 1lAL I OH IINDIVIDIAI.)lv,(ME rIPI)) DAVV rIpb �1/� k AA)t)O ) UEIUlFICATIONl /
)-
''111 41N l It:\Cl Ult cIMPANV NAI\IE \-/yc-ram.-�`�+— l.(�L ! )/z; II to PHONE N fF0318374$p0O
SI.tIi'tr1'. 11. CONS IItl'(' I ION I'r.Ra1IIN_ ASSOCIAIEI'\\ O PEItA 110
(if applicalrlcl (if applicable)
I. \VFL.l. I ISF. ((heck Applicable (lox): Residential hd"-Itmicipal/Public O Indust' i: l O Agricultural ❑
Nlnniloling ❑ Recovery ❑ Ilea( Pomp Water Injection O Other ❑ IFOIher, List Use
2. \VIII. I ()CA1lON:
Neal est l awn: M�! it oCounty aJ L
Barn nii,nr. NuuIas, l lnnmmwily. Subdivision. I nt No.. lip code)
1 n\VNiIr :—.I.C., , RA-?�r,2D Idcrrers'minu'cs(seconds)
Add'css `I5__ 1S14Bt .h b Latino ellongiludc sourcc:OGI'SOTopographic map
Vince' a' Itic � (check box)
Alugpky Ai L _4 /__�Gj )FI'III DItILLINGLOG
(iIv in 1 l'' slate Zip Cmlc Flom --- J:a Fon ;Ilion Dc8)l nn
( )- 27 — 75_ �J
A 1 rn _ntic Minor number
A I)A I F IItll.I.F.D
5. 1:( VI-AI.DEI'III:2S• /
6. DOHS WELT. Rli.l'LACE I XISIING WELL? YES El NO IA'
7. S IAl It WA i kit I.F V IiL llclow Top of Casing: A-) ET.
(Use "+" If Above 101. of Caging)
8. IOI' OF CASING IS ____/_ _ FT. Above Land Surface
• I iq, mr (adn'I ferrminated al/or below Innd sorinte rapdrea a
,:nl:o¢t In ncrordanrt 'Int 15A NCAC )C .17119. n. YIIII.D (rpm): _1-%J__ METHOD OF TEST `7
//12--
In \\'A ILE 7.ONES (death): --
I I. I)ISINII!(:I ION: Type C Q/2F Amount 1 c1-1
12. ( ASI NIi: Wall •fhickncs..
Depth p Diamclj•r or \Vciglull9. NNllalerial numbers and common mad mimes.
Itom__Q 1L__f_2 IT,ifJ/I S�42/ LV(
Ii (1111 to -- I t.
•
Itnn_._. To PI.
11. (;It11111 D 1.IIi /�Matcti; l Method C
I tom 0 To Et. Ce- 2 ( r�Aloy
1 imm go To 7a F(. Cit r /i95 710-00(,V
1J. S' i'ITN: I)cIll' Di:nncicr lot siic J NlnlciiI4
Ilm To IT in. in.-....__.__-
Ilom To PL iu. in.
15. SANII/GRAVE(. PACK:
Ikolh Si>c Nlalcrinl
110111 to N.
11om Tu 11.
Topographic/land selling
❑Ridge LUSlopc ❑Valley Una,
i chuck nppl nprinle boll
L lilude/longitude of Well loc:llion
16. RPNL\RKS:
-npt(N:d Im 1
1616Pl okNkri'
LOCATION SKETCI I
Show diicclion and distance in mites from al leasl
two Slate Roads or County (toads. Include the roads
I IIA I I IIIS WELL WAS CONS I RIJC I ISD IN A((UItDANCP WI III I5A NCAC 2C, WELL
Al S. AND IIAT A(;G 'YOF 11115 I CORD )9 IIIIIIN I'IWVIDIEI) li)111E WELLOWNIiR
v�ti
SIGNAIIJItEUl PERSON I(INS IRUC, 'WWI III' .WELL DAIF
Division of 11'ater ()tmllty, Gruunihnller Section, 1636 Mall Scala Ccntcr - Raleigh, NC
733 3221, within 30 days. (iW-1 RUV. 07/2001

273172
11'LLL CUN51'1lUC:'1'►UN IUD
1UAW
ccrtl ItICA uoN 1 a�oU
Nollh Calolinn - Ocpallumnt of Euvhoullle,ll nod Nalulnl Ilesomccs - I)Ivlslml of \Vniet Qualify • U 111IFI Cole 5'-r oii
�5
II ELL CON I RACI OR (INDIVIDUAL) NAt'lr IInI"I) i(-v pIWNP. L( )�
Y) \ C
IN St LL 1%Ill CONS I(C(IM ION l''NAN F',---�SSOCIAI I!U WI) PERIM III _—_,—_---
S I A I E „-EI,1. CONS I IIPCUIIN PEIUII I_ -----
if n I rllcablc
ifnrdREAR
1. WFI.I. USE (Check Applicnb!e Ilex)•. RcsiJculinl Bi/Mmlicipal/Public U IuJusllial 1 I Aglicullulal
Monittning U Rccovcly LI Ilcnt Fillip Wnlcr tut eution U Ullicr U If Other, LIst Use
'I opuglnpllic/Lald sclliu(;
Midge Licht', IJVniky UI'Inl
(check •pprr.pr late Ina)
LnllludcJlougilude of ,veil locnlion
I1IrprerJnl1 , 1rJae<rtub)
Lntitudcnm,eilude soulcc:LUltra
I eek LIal opoglnpllic le III
Li01.1.11)U LUST
Emu liescripliun
/Q
2. \VELL LOCAl1UN:
tJenl cd' Irmo
1 PS1mtX.tcil _ -
'Sorel ?Woe. Nmnikla .•....
e w\�p rS
7. OWNl?IL•w�--
Address 3ret
I�/�1` y v ISlleel c'I noule Nn.)
n T�_
Art. rc.lr. Throe number ar
4. 1)AI1°. Nltll.1.1'.1)�0�
5. 1 o1AI, I,E1 I I �9� _
6. 001?S WE1.I. fu'I'LAU EXI S1111tt \YR! I 1 YES U NO lu-
7. SIAIICWAFEItLEVFLIIcloav'1opoft'nslog: /eo_.._NI.
IOae",'U Almvr lit °Wetting)
F. 1 UI' Or CASINO IS _ _ 1--- E I . ALovc Lund Sol Ince•
• (r', rl r.dnr Irnuln.irn *Ito brlo" loot nnl.rr 'undies
atom In •err mane r..Idr Ix,\ MCA(' )C.01111.
ME1BUD 0f'I)ESIYL
Ill AVA1ER ZONES (depot): --
County
liv, SabJi vision. Lid No:, 7.Ip Crtle)
— ni Slme Zlp Code
• or nil
)�IfU.
Elom fo
/p' 7LQI
1 III' 'Amount _y Iwo 51n IC Itoprl9 Of County
Ennd9.
11. CA51Nt;C IION:'f)I'c \Noll I hicknrss
12. CASINO: Uimncter or Wright/O. Mntclinl uuu,b cis dud common tond onii$
U(plh �1r
rmuL�— fl. — -
Ervin_ In__ i1
Mnfclinl
I]. UROU1: Ilgal, , Il. Gh
how D �h°�-
1t,_ __ II---- --- .
Prolo. _- Uimuelct Slot Sire
14. SCI'!:pNl' Dinh 11,. In.
11 _
plum p..__ _ in. In.
Ilonl_ _
lo----I1.
15. SANI))UItAVI'l' IACK:
horn fo
from Lo_-� tiLr--"_—li_ 1
r
Sire
1( REMARKS:
Mnlulnt
Mellott
Mnlclinl
n t —
MU' SYI;)_cit =
ilecllml nod dislnnce In tnilcslcltoll'
u the nd
0 0
REMARK �— �1 tvELl.
1DOIlliREL1YCERIIEY 11 Al`IIIISWEI.1,\VASCON. lI d' ItIACCUi lJAMICEWIill I5AIICAC2C,
CUNSIRUCIIUNSfAUR/'WS AlIU 11IAI ACOI'YOL 1411 FCUIIUIIASBERNI'itOVIDEU10111BWELL OWNER
51Uti-mtftu OlLEEtt4uri"CONS ItUCI!Nu 111EWELL
DAM
i ISfll Jt.
Cyder
l(ai!l ht ric l
Submit Iht n1lRlnnl In the 1)Irl(Inn of YVnlrr I�,nlllly, CI nm111lrnler Section, 1636 Mall Service Caller - Ilal(II(h, NC
1)Daa.16)61'honc No. VIC)1)1-J111,11Willi 311 tiny,.

WELL CONSTRUCTION RECORD
273156
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print)FI? ay./ Z , wczoR CERTIFICATION s 31 75
WELL CONTRACTOR COMPANY NAME RYc-(zS WC-LL (RILL/ M cc PHONE * U7E) .7'9' -2I(nG
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMrT*
ifalicable if •rlicable
1. WELL USE (Check Applicable Box): Residential Ls! Municipal/Publle 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery Q Heat Pump Water Injection O Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: fMURtQRY County C/4Et2o(;Cc
LLV(Ce) I,crS'/,./Z,/3 9Oco
t (S: x: Name, Numbers, community, S6t,divisia , Cot No., Zip Code)
�7 Rc,.3Cy25oM 2rD,
3. OWNER:RICV NU 6
Address 4 in i0 — e).E F APORT i11Y4
(Street or Route No.)
PORT-- T t vclC, FL 34G5Z
Zip Code
Ci- 37- 7
ty or Stile
V2.3(0(0
Aron code- Phone number/I
4. DATE DRILLED '1-1_7 03
5. TOTAL DEPTH' ? 2 5
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 19
7. STATIC WATER LEVEL Below TopofCasing: .QO FT
(Use "+" I(Above Top of Casing)
8, TOP OF CASING IS j, �Z FT Above Land Surface*
'Top of cola; terminated aWur below land aureate requires a
variance In accordance wills SSA NCAC 2C .e118,
9. YIELD (gpm): _ 12 METHOD OF TEST Ft /t2
10. WATER ZONES (depth): » /5
11. DISINFECTION: Type
12. CASING:
T
Frcn(IO Depth
141—ET Amount. `1 o z
From (o Q To C7
From To
13. GROUT: Depth
From 6 To 20
From To
14. SCREEN: Depth
From _ To
From_ To
15. SAND/GRAVEL PACK:
Depth Size From To Ft.
From To Ft.
Wall Thickness
Diameter or Weight/Et. Material
Ft. Cam 1/R ,51A97/ ;PPG
Ft. a rt17727
Ft,
Material Method
Et. ('ia'&vT ri Qvii v
Ft.
Diameter Slot Size Material
in.
in.
�//Topographic/Land setting
IsRidge OSlope OValley ❑Flat
(chock appropriate box)
Latitude/longitude of well location
(d pdees/misutesisocaods)
Latitude/longitude source:OGPSDTopographic map
(check box)
DEPTII DRILLING LOG
From To Formation Description
O 6,5 , coF! 5-,),froY C2e✓C7eni)
(n 5 572 F??ow s.:l41V (SAL/ re,(/)
7 /ns 7 srlf�cE_Fi�2
5 /72 Oj1Wv7, ).
!77_ /7.5 tJJdTJ Agin 4pIc
/-7 S 27,C (n?R✓ `-PARtfi Cic-
0
m=
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.
PtrC
( J Gppr
Cr) o
0
co
z
R
3 Mi /:ia"u'ERS°T
cn
16. REMARKS: vu t i2S u(t ce
CQNST RU
Submit the on
2707 1636
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
S, AND THAT A ►a PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL. OWNER
0
SIGNATURE OF PERSON CONSTR u I IN0 THE WELL
4 - sy .-03
DATE,
to the Division of Water Quality, Groundwater Sectlon,1636 Moil Service Center - Raleigh, NC
o. [phone], within 30 days, GW-1 REV. 07/2001

273155
WELL CONSTRUCTION RECORD
North Carolina • Department of Environment and N tural Resour ees - Division of Water Quality • Groundwater Section/
WELL CONTRACTOR OIVOIYInUAL) NAME (print) / Q i7 / //,1r� CERTIFICATION #Y 3/
WELL CONTRACTOR COMPANY NAME /.7 `V/T0- I'v%t'!( i96 r///r j PHONE # (74 I4r 2/6.f
STATE WELL CO; ISTRUCTION PERMIT# ASSOCIATE)/ WQ PERMITN
if a. licable if licabl
I. WELL USE (Check Applicable Box): Residential MunicipaVPublic 0 Industrial O Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water tion Cl Other 0 If Other, List Use
2. WELLLOCATIONy•
y�
Nearest Town: /y/�tten/ County ✓;7f,464/��
/9sty Cir4ad;Aent 2orid a.281ot
(Street Name, Numbers, Community, Subaivviiission, Lot No., Tip Code)
3. OWNER: L K, t ti//Y
Address 31S 1 oResi CIrlr. C (Lelp,
r1 (Street or Route No.)
�J'meR1CVS (en. 317cg
City or Town State Zip Code
0,29)- 9e2 t7)di44F
Area code. Phone number
4. DATE DRILLED Q `.2 o
5. TOTAL DEPTH:___ ` r /
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO C5
7. STATIC WATER LEVEL Below Top of Casing; oas
(Vac "+" if Above Top of Casing)
8. TOP OF CASING IS 2 FT. Above Land Surface'
'Top of cuing terminated at/ur below land surfue ttquirti a
variance In accordance ANCAC 2C .0118, 9. YIELt (gpm): METHOD OF TEST A,1/1"
10, WATER ZONES (depth):
11. DISINFECTION: Type H7,-/
12. CASING:
Depth Diameter
Frorn_a To A.26 Ft.
From To Ft.
From To_. Ft
13. GROUT: Depth Material Method
Front_C' To Qom' Ft. C ./01776"- 7 c,-4 ' T
From To Ft.
14. SCREEN; Depth Diameter Slot Size • Material
From. _ To
From _ To Ft.e jn. in.
15. SAND/GRAVEL PACK:
'Jtpth
From _ _To Ft.
From. To Ft
16. REMARKS:
I n0 wpRrnv
Amount
Wsll Thie nece
or Wei Wt, Material
ca. i 'trc
Size Material
'..'. CONSIRU
Submit the or 'gins] to the Division of Water Quality, Groundwater Section,1636 Mail Service Center - Raleigh, NC
27699-1636 Phone Not [phone], within 30 days, GW-1 REV. 07/2001
r
/Topognphic/Land setting
Ridge OSlope OValley ['Flat
i (shed, appropriaw box)
Latitude/longittide of well location
(degreeslminutes/eecoads)
Latitude/longitude souice:QGPSOTopographic map
(check boa)
D1 P i1 DRILLING LOG
Frglo T� Forma n Description
oo
CJ •{ W ix0 /AWE-
-
- to
0
cs z
z
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads Trchule. rwe .run
numbers and eomrnon road names.
N —
V-17Y THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 1SA NCAC 2C, WELL
ARDS, AND THAT A COPY 9F9[fllS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
3—
S10NATURE OF PERSON CONSTRUE LINO THE WELL DATE

WELL CONSTRUCTION RECORD
will, 1'aloliun - 1)cpaitmctll of Environment and Natural Resources - Division of W;itcr Qualify - Groundwater Sceliml11
'r. .,.,- C /11 %1A 3•v/iJ rru ncrrA LIONM �NII
o el 1. 1 lINl It \t'l MR (INDIVIDUAL) NAME whit)
(rl'I I. 1 (IN'I ItA(' I Olt COMPANY NAME.
lCAl —ec BRi it1'v) I'IIONE a f *-S) 337--&cc
5.
STAY rrI:1. I.(lr'\SIIt 1'11ION I'E;ItMIIOl ASSOCI%'I El) WO 1'6:nn111N
Of applicalrlc) lit aplrlicibtc)
I. \VI -I. I. I ISI! (('heck Applicable Ilox): Resideulial lld' Itinicip;d/Public ❑ Industrial ❑ Agricullural ❑
Monilur ing ❑ Rccoccry 0 Heal Pump Water Injection 0 Olhcr ❑ If Other, List Ilse
2. VV11.I. 1.O('A 11UN.
Neatest T,, , A) County
Gaitce. Air 9— Leek IA)eLLC bR
„het, N:.n t. Nnmbcic. l'ummanily.. Subdiviisslion. lel No.. Zip Codcl
Addle« JS- .f3u/..�ILSCAPOL. NSe 12b
(Sn, tl n Route No.)
Hy -yes Y, fie Nc
(JR. i In¢q sink,
Zip Code
(B)- cc3T--WL-'
,\tr= ,odc Thole nnnd'ci
1 1)A FE WWI l.D %-/5-03
5. in FAl. DI:PTI I: Ica/
6 DOES \YETI. REPLACE. EXISTING WELT? YES CI NO 13(
7. S FA I I(' \VAIIiR LEVEL Below fop of Casing: G 3_1 ..
(Use"4"if Above lop or Cam ing)
R. 'I ()1' OL CASING IS / 1T. Above Laud Surface
•lit nr rndng Icrmhmlyd n Vnr below I•I,d snrinre requires •
t-.vlace In nrrnrdmlce nhb I5,\ N(A(' 2C .a1IP.
e. YIIII.0 Iglnn): . _U?$n-i MEII lop OF i t sT
u. \VA I FR 70NIiS (dc1'IIi):
273055
Topographic/Land selling
[bridge 0SIopc ❑Valley ;d
(check appmpiialc bn<)
Latiludc(lotigilule of well location
(tic pi rc canon Ics/s eunuls )
I alil(nlellongilndc soul Topographic Innp
(check hall
PEP III DItILLINC LOG
flow 'fo Forntaiion Description
C1
Ss-A'T
C /— 38'
3-'-SSQ7'
II. DISINIF('IION. Type Caokitlet Amott111
12. f'ASINI Wall Thickness
Ikplh Dimt c er or Wcighl/II. biilcrial
IImo O •In 3$_.11. CoXz _at PVC
inlll To 1t.
1om .f)1--_._ 11.
11 GIt(It)I.• Depth Nlalclial Alelhad
I tool III 31 11.Ge/1tePy C1Akio
limn _ I-o 11.
1,t S( REED. Deplli Di:ntclei Slut Si,c
non I ii H. in. in.
IlHim .._-..fa f1. in. in. .
15. SANI )f( iRAVIII . I'A(. K:
I)rpill Sim Malct iat
I ono lb 1.1.
I non
11 ` 6�
11111/II L1 H1't'I It 11I
crl I !WU NlN ST2
Nalel i 11
en ar-
W
S
a
CD
LOCATION SKETCII 3 �o
Show (Iircclion mid (lislauce in miles from alainstrn z_
Iwo SLlc Itn;itls or County Roads. Include IIgroai'i-1
nunthcl s and common road names. 0 0
\ f l His Will.l. WAS CC)NClltll(' 11.1) IN ACCORDANCE \VI 111 I SA NCAC 2C, Wlii-I,
U LDS, AND II IAT A COPY 01:111IS Pr( ORD I IIAA�S BEEN PROVIDED 10111E WELL O\VNEIt
SIGNATURR. or pr.. tSON cow: I Rt1C'IINu IIIP WEi.l.
[Milt
AL F` JStilrfRlzhltall eia'igni,d 1(1 the Division of \Va1er Quality, Groundwater Section, 1636 Nlall Scrlice Cenler - Raleigh, NC
27699,1616 Phone No f9I4)'731-3221, within 3l) days. (iW-I REV.1)7/21)01

WELL CONSTItUCTION RECORD
Noi Ih (:n nliuo - pep, (mew of Environment and Natural Resources - DivisionofWale) Qualify - Groundwater Section
ttt Ll.( ()N-I It A(' It)It(INIDIVIDUA1.) NAME (print) 1Q1/CD �^,, /t111CA/-ln1 CEI4IIFICA HONN$ II
('
ss FI 1.1l INl It \IOIt ( orkII'ANAMNAMEJILpofroe 1.S k-L bRi Ii�9—I'IIOr4E M Pot)19��"' DO
5I .(11. \ II I. S'I lir('I ION 1'El(MI'IN ASSOCI %I En \s'() I'EItN.I/I1I
I if applicable) (if applicablc)
273054
I. \\ hi.l. IISI'. ((heck Applicable Box): Residential 11 Mtiniciptd/Puhlic 0 Indusnial 0 Agricultural 0
NIouinning ❑ Recur cry ❑ Ileal I'ump Water Injection ❑ Ulltcr ❑ IFOlher, List Use
2 \\ LI.I 1 u('i\nor] y�
Neal cc( l llwn' n7K Cotud_ 1cyO
CN.Nio n))
t'lu, ct N:nnc. Nwul(Is f-nnnulmily, SuhJi vision, Lot No.. Zip Code).
1
7-37 —86-03
Awl code Phnom nounber 7
,.1. DAlli DRILLED if-a'� 'O
5. In I -AI. DEI'lT 1: ) is ' '
DOES WELT, REPLACE EXISTING WELL? YES ❑ No a(
7. SFAT IC'WATER IEVELllelowTop ofcasing: _2 •
Pl.
fopngraphic/Lmld selling
❑Itidge [JSlnpc ❑Valley -lal
(check nagoir iale tin.)
I alitudc/longitude of well location
O\\'NI'R'. Si A+� Il/T'z 3e_t� _ Idcgreccgnimncs/cccondcl
Addlcss /07 L/lrnQ1o_,�Ia,.1 t3 /�1�1 AD I,, / Lalitudc/longiludc source-06E30l'opographic map
CI r 1 or Rollie No.) i (check host
Ar1/•yy���I.1. /JC 2P9_ UI_I'TII DRILLINULUG
1 �,� I� dI, / Stale Zip code Pluin l u I Formation DT.Ccription
S)
L4J2► & 1!C
(Use "4"if Above lop of Casing)
5. I ( )1' OP I.'ASINCi IS / ET. Above Land Sul faces
•l np of racing Iero,InnicJ al/or hrlmv Iaud surfnce requires a
.; at ;lure In ncrordanrs* ilh Is,\ NCAC 2C .al IR. n
(/YII:ID Igloo):__lL`___MTEST_
Cr11U OF /4/_.-_
la. WA I lilt TUNES (dup110:
IL DISINI:F('1l()N:1ypc ri'LO/21Nf Aiiio,uit
12. ('ACING: Wall Thickness
Dcplht)i' up er or Wcighl/EI. Malciial
1111111 --i .11)__.r%_Y�]-]_. El._ ((��,, y2 sbe.2l P✓(
1 IOIII_----- 1 P 1'1.
r i llm -I-n _----- 1.1.
11. 11R(11 I1` Depth ^Malcrial NIclhod
1 inn -_ 0— Ti. au ft. S�QMe'`J T cAm✓)Tx
Mom �0_ 107 _ II.Cui7')^/ s `'��JJyam✓1.7y
Id S1 RII1N'. Dcpih Oinincicr Riot Sire C hlalclinl
Ir1,111 to _._. I'I. in. in. ___ ___
110111 1(1 I . in. in.
IS. SANI)'( i RAVI!I. I'A('K'.
I) pill Sim Material
tom IlIVI.
f / 7c)
7)' l45'
Iloin lli____.___11.
• •l1
I I), r I II PI Hl• f I'It I ivy IIS 1l'IiLI. WAS CUNS11tU("I P.I) IN AC('OItUAN('p. \\'I III I SA NCAC 2(', 1VIil.1,
: (INS IIkI1'IIONSIAND\RD/S,AND 'IHAT curictulsR r'ORUII SBEEN PROVIDED IUTIRE WELL OWNER
1
O
c_
0
a cr,
Cl<
f) gm
LOCATION SKEICII a mtD
Show direction and distance in miles from al IMI ziR;
No SIale (toads or County Roads. Include Ilie.srd m�
nuuihcl s and common road nnmcs. _ O -+
0
Z
TE
Ye .l''ILLE REI'
Suhuiil Iht ori(!inul lu the Ili isinn or Waler Qnallly, C:cound)saicr Secllon, 1636 Mall Stt'rive Ccnlrr • Raleigh, NC
276711.1636 Thine Ni'. (1117) 713 3221, %slihin 311 days. Ci1V-I REV, 07/21)01
SIGNATURE OE I'EItSON CONS I ItUCI ING'1I Ill WELT, DA'i E

WELL CONSTRUCTION RECORD
273053
elm ill tar nlmn - Urp;umlcnl of ['civil -oilmen! and Natural Resources - Division or Wahl Quality - Groundwater Section
\\I'lI. l ON l P\('l(llt (INDIVIDUAL) NAMEpr(nnd),, , i4V 11) • 144)&3 ,-) CEIrFIFICAIION N .fl
ul'LIJ'(IiN'I It NCI (IIt COMPANY NAn1E ( /�P Kn >o l�l IAA) PHONE 0 f3$)53.37-8C08
S I ,\ Ili \\ l:l.t. ( DNS I ItI ('I ION PERM( I N ASSOCI AI ED WI) PERM! 1 M
(if applicable)/ (ilapplicablc)
1. WCI.I. IISE (('heck Applicable Box): Resideutiali Mtinicipalll'nbre 0 Indusllial ❑ Agricultural 0
lonitte jog ❑ Rcco\cry ❑ Ilea( frump Water Injection ❑ Oilier ❑ Irother. List Usc
2 VA I I.I. I O('A HON: //
Neatest I own' "Cit � CounlyChe�het
/ P HaR.T %n (44Ce- /11TN fl
C:norl Nome. Nnmbci (. t lnnnwnily. Subdivision, Lot No., Zip Code)
1 O\\ NE.E: OIvbeLL A.oteaSOru
Atbhtss /'/7,5 _ilipa T- 9 -Irtn- HSf kb
JJ (S11,111,1 mule No )
4(eSii I f e i /JC 22O 1
t IDloon Stale Zip Code
t8)-S1- ?37 ^ %°
Ain CI* rl,onc 1n,n,brt
4. I)Alli NULLED
5. lO1 AI. 1)E.I' I I I: 7.2.)
r
6 OOJS \Vlll.l. It f. I'I.A(t EXISTING WELT? VES 0 No C
7. S I Al IC WAl ER LEVEL Below Top of Casing: CYO ET.
/ (Use"s" if Above' lop of Casing)
8 1 (11' OF CASING IS L ET. Above Land Ste Inca"
'lop or r:nhte let ndnatcd al/tor below Innd surface requires a
atl:ume in accordance wnh 15A NCAC 2C.011R.
Q. \ III.D (rpm): __-- METDot) of TEST AJ2
(1. AVA I ER RONIiS (lichlh):
I I. OISINEI!Cl ION'. 1 ypc ( AL90 )Q( jAmount _ _i csl
12 ('ASINU Wall 'thickness
I
Depth Name er or Weigle/H. Material
(iota 0_ 'lo '2(1 l'I 1 ack p_p_t AIt..
Mont _ To 11.
tont I fl. .--
I1. (iltO(I I'`-- Depth Malctial
lom --C _-I\t 7-0 It CgN1PNL
10111 I o 1-1.
slut Silt
Id. ' ('Itlil!N: Depth Diameter
tom 'Io
moo lb
I . SANI)/(IRAVEI. PACK.
Depth SI]C
11)111 Io
I rian To
III
VI f �5uaS 1 RUC ,
IIf-: 111 I). (ONtilllt)NtiIA
in.
Material
Method
M:uet inl
Itipogrq)hic/Land sclliugg
[Midge ❑Slope ❑Valley !glint
I duck nppmpti;ne bm1
1 nlil ide/longitude of well localism
Went rcdmim teshccunds)
Laliludc/Itmgil lc soulcc:EI(,I'SLJTtpographic map
(check box)
DRILLING LOG
Formalism Description
S zfF�
imp I11
How To
2FJI J�O1
O
3
en
LOCATION SKEI CI I N KR-
i>'-
Show direction and distance in miles from:, nsl me
Iwo Slalc (toads or County Roads. Include 1 re roar z
J mz
nuuthels and common load names.
O —+
O o
1 1111S WEI.I. WAS CONS IRI)('I III/ IN ACC(lltl)AN('E \VI III 15A NCAC 2C. WELL
)S, AND
.1IIAT A COPY OI-I111S IkECOItD IIAS BEEN PROVIDED 1OI11E WELL OWNER
} SIGN; DIRE OF 1EItSUN 'ONSIlt(1CIING1IIII WELL DATE
�114120}EPntgin, i-Iq)flhe vision of VPaler Quality, Cr(iundwaler Salton, 1616 Mall Sees Ice Crider - Raleigh, NC
Iit, Nn. (91'I) 731-1221, within 311 dnys. GeV -I REV. 07/2001

273052
WELL CONSTRUCTION RECORD
rJ nili ('nrnliwl - Department of Environment and Natural Resources - DiviSiinn �oll Water Quality - Groundwater Section
\UI.1.. ( IiN'I um- I run IINIIVIl)tIAI.I NAME prinl) 1lAV Lb1IF('
I ,�/'J'V T�1(.O/J CERTIFICATION
snl.l. r ON IItA(' I OR (Odll'AN1' NAME ileAn�e rcr..3ILL_bR,')ila/ PHONE N 18.16)47
SI.\I6:wI:I. I.(ANSIRO( "IION 1'E10111N - ASSOCIA'I E11\1'OFERMI IN
lit applicable) (if applicable)
I. \WEI.I. IISE (( heck Applicable Box): KcsidenlialI Minlicipal/Public CI Industrial L7 Agricultural D
Moninving LI Recut cry ❑ Ilad I'uurp Water Injection ❑ Other CI II( , List tisc
2. \\'EI. 1.1 /CATION.
Neal est Town'. /)1 UQA
PP. _kr1 1 tLlIs
Karel Name. N�Ip',iI iI<. Cnllununily, Subdivision, (.all' Neu., Zip Cutlet
1 O\\ NER t )709 RC AB i yv
Adlbess / ay 3
SI tl,1nourNo71
CounlyC ke kte_
/I1403L.E. {{ 1BIOS
�t p( ilc �n I..an Stile Zile ('nde
VaO)- Z. 57— _
tod, rennC mmdrtl
4. DAIIt DRILLED) '—.?_ —O3
5.111 AI, DEBII 395'
6. DOES \VI:LI. REPLACE EXISTING WEI.L7 YES 1 NO E
7. S IAII(' WATER I.EVEI, Below "fop of Casing: 'fl_-fl.
(Use "+" if Above Up of Casing)
R. 11)I' OE CASING IS �_ ET. Above l;mtl Stu races
• I op nr radug tenrdoalnl nl/ur 'who/ Inns ,nrract requires •
,:n la"re In nrrardnnte o lln I5A NCAC 2C .0I IM.
(1. vn].u(ppiii): /0 METIIODOFTEST R/a
In. AV,A I I.R /.ONES (depth):
Topogun uc/Land selling
❑Ridge ..lope ❑Valley ❑plat
(check slipup( Foie box)
I.otiludc/longitude of well location
IlIcgrccshi1inutestsccnnds)
Latitude/longitude soulccIDGI'SOTopogrlphic map
(check hot)
DRILLING LOG
f(nurition L)cscripliou
kn h C t-�f
UIil' 111
plum Tu
-rQf
13p' 3't5'
O
c>_
—e
z, r,,
—_Sa<
N gm.
I I. DISINl l :lloN: l y ,,- Lnlr i'e Amount / ale,
12. CASING: Wall Thickness
I tenth rr Diameter or WeighUPE. Mate(ial
I tomllh !-3`) I'(. c VlJt s't i_ PVC
1hom _ 'ro _ 11.
I,oni "1rr Ft
I i. (ilil ill I Ihplh Alalcrini Method
th III ejI I1 2Q __ l't C`Pr�e^�r _PAY Dr
I .t hhh a .J 11, /Q-_ EI. Clan / MVL
1.1 Sr I211'f1: I >c1Vll, Diamcicr of Sin pLucli:
Inns_-. to-,--. IIin. in
I tom Ta I . in. in
I5 SANI)1(;12AVEI, I'At:K:
I)cpol Sim Matcriai
Isom to Et.
1 nun To El.
LOCATION SKETCII a. m.'
Show dircclion and distance in miles Roue �12cas t
two Slate Roads or Comity Roads. Include U lo(t 55
numbel5 and common road names. 0 t
O 3
Z
I N!:111 4 UY ('p t I Ii'T I MISWELLWAS CONSI RU('I ED IN ACCORDANCE \VI111 I5A NCAC 2C, WELL( ONSIItIN I ION SI AI S, ANDCOI'Y (Y ITS RECORD I IAS L2 PROVIDED T0'I'l IE WELL OWNER
if-,e-a3
SIGNATURE OF PERSON CONS RUCIING 111E WELL DA'I E
SC'JDWATER SE
t Gr CCIli61MliG(OdwihiuhNli�llie ivisluu of Water ()wilily, Groundwater Section, 1636 Mall Sus Ice Center - Raleigh, NC
2769'1-1616 PImrr No. 1919) 7. 1-3221, (rilllin 30 days. (AV-1 ItEV. (17/21)01

WELL CONSTRUCTION RECORD
rim'', cal olin:l - I )cp;u anima or Environment and Natural ,IIkesutiiccs - Division or Wale' Quality
\\I'.1.1.1-Iln'lu \C 11 )It (INDIVIDUAL) NAME priuQ )A_vl.f..i t1• ]� ck)u0�
ss El l.1-(IN I It s C I Olt COM I'AN 1' NAME Lc ankee life IL -1JR11lt'37
S I A II. \t'I'.I.A ('ONS I ItS("I ION I'E10111N ASSOUTA11 k:1) \yl) 1'EIta1I I H
l if applicable) .. Of applicable)
I. \\'I'I I. I ISI1 (Check Applicable Box): Rcsi(lcnliadhltinitipal/Public ❑ industrial ❑ Agricultural ❑
Monilnling ❑ R•ctocry ❑ Ileaf Pump Water Injectioti ❑ 011icr 0 if Other, List Usc
273050
- Groundwater Scclion
nit IFICATNON N 211 f 1
I'IIONE N 1?1g37—BO2
2 AA'I'.I.I.I.UI'AIII-IN-
Nraicsl 111011: IIIU
rl SyI Snr(l N:nne. Number I'm
Couuly �Q_—. vritokee
nm wi 11 y, Subdi vi sian, Lot No.. Zip Colic)
Address lly8�
e to
//�1 Isnmi urn lc No.)tol�-kQ 90�
( 'ilv I �� Stale \/` ZipCode
Air:l rode. Phone ire numlmr
4. I)AI E DRILLED S —1 —()
5. "LOFAI..lWl'T1l: Linn
6, DOI3S WIAA . ItPI'I.AC'E LXISIING WELL? YES 01 NO 0
7. S I-AIIC WAII',It LEVEL Below Toy of Casing: cp. FT.
(Use "4" if Above lop of Casing)
8. 1 O1' OE CASING IS / Ff. Above Land Surface`
• I,q1 of ra'blg lrnniuslrll atfor Isla\ land sarfnce requires
s:nl:u,cr In acrnrdnncr ',ItIi I5A NCAC 2C .MIN.
n. \'II:I. I) (ppm):_/OQ_ METHOD OF TEST /4/Q-
111 \VA IFR /ONES (dcldh): ZaQ )
I'npl,graphic/Land selling
❑Itidgc ❑Slope [Walley laPial
(check appr uplinle host
I .a(iludc/longiludc or well location
Idcgires4ninuleehcanuisl
L:diluticAungiludc soulcc:❑GI'S❑Topographic nap
(deck box)
DI:P111 DRILLING LOG
Hum To Fo motion Description
6.East
51—LIST
215)— R05'
11. NISINFl UTION.14pC.i.._binaD_'C Amount 1 ClE
12 (',\SIN(i: Wall 'thickness
Deitch, Di' mgl •t la r, or Wcighl/Ft. icrial
anal _.Q . fo_2].S 1 1. SD211 Vr' .
Eon, To H.•
Ilo1 __ To H.----
I3. cumin. Depth NM;iieiial Methodfi."i, (0 111 /3 rt. l Q 1e&)T eitip.✓rT�
I tom To It
Id. St 'It Itl: ft I)cpui Diameter Slot Size NIaleiial
non1 Ta FI. in. in.
1- tom 1o.------Et. M. in.
15. SAND/GRAVEL PACK:
Droll' Size Material
1111111 lli P1.
Ilona — To 11.
16. RI!NIAI&KS.
1 )NS I RI I('11UN S 1 ANI )A
s ilillriQilt'IG)'' AT,�y� ��4 j'i:11 p1) i r i s
As u1u
fV 5
0
LOCATION SKE'I CII
Show clitcrlion :old distance in miles rroni ai.i'asI4
Iwo Slade Roads or County Roads. Include 16 toatE
nunhcis and common road aerates. O Cl
IS WELL. WAS CONS -NOW I ED IN ACCORDANCE WI III I5A NCAC 2C, WELL
ND'II I 1' A COI' OF'i 1irCORD IIAS UP 'N PROVIDED TO THE WELL OWNER
SI ;NAT111tE OF PERSON C%)I4i} I IttiLtING 1IIF. Wlil.l. UAlli
n of 1Valer Quality, Gri)undwaler Scclion, 1616 Mail Scarce Center- Raleigh, NC
I, nlllidn 30 days. OW-1 REV. 0722001

276102
WE'LL GUNS IIIUCI'IUN 1ECiii
CF.Il11FIG�lIUN�
�l
Nord, Cmuliun - Ucpallu¢nl of larvlwnrilclll and Nnlwal llcnuulccs - Division of Wale' Quality - CL11I Hick;
n I ?
t1 ELL CSINIRACIIrII (INUIt'In UAI.)NApI F. Ip'I'11) N :`-
4-061
rcr.nI a •37- 7
tvELLCIINIIIAC'1011 CtrN EANv NAME
- __------
5 f A I E. ft E1.I.I onl1c
f NS I -110H l'EIU11111 _---- ASSUCIA1 P,11 tt'Q FP.IUIII�
if n 1 rlicnblc
Applicable IA): Residential bk"--MlrrritJpnlirliblic U lu(1101 l 1 I Aglicuhurni U
I MHi.L USE ICI Rcc :c Ilcal rimy \Vnicl ligedimi LI Ulllcr U If lithe', List Usc�-----
Mnnilnlil,gU Iteeuvay U 'lonoln npl,idl.nlld selling
�,�����,� Mini
2. R'P.LLLr,)r_-AIIIIN'. Ci"' UII{iligc LISlnlre UVnlley
CUpIIIy— (ch.rk ^In,q,rleie i,^•)
Nenlcci-itnenl_ `^\, `.n. .. litTler g
st w i-n,,,�,. luu iludc of well lucalian
v' Lei Ho ell', Codo
ICb RI Iln,np I lilrltnrJnnnnlrJt•'^ndQ
rr
,-----S;�_ �1 ` Lnlilu :ll••nLrilUJc snulcail. il';I71apoglapllic n'.'p
1. O\I'IJ I'l'_ ` 1�-- J. iy>r IchecA l,•,•)
AJdlcssiii RU Ali ►IIULLlt7t1 I t�11
I$bL of -- --- ,�QCj
'� to I'onnnlion Pesulpl n
C- A_ -__- I'lolil ��
$Inge lip Code � 4
cIl) of l n„n
Art, r,.lr.I'hrnr number_^ 0.` --
i. NA11! UIiII LIIU /5f 1)
5. 1IIIAI. blil'1II: gui1 —"
---- - - ____
SU I10-
6 SIRS C WA:IiEll LEVEL Below "lop\of Owing: ESLt__
7. SInlIC ffl,r••r•IfAbove-Iol,ofCnil„R)
i IS `_ Ir I. Above I.nnd Sul Ince'
B'I ill' I rPCAS IN( _ ---o.. lend ,,„b,te@tnuht*.
. •Irp rlttt ornn„r, nilit r,.r lido.,
,nbnte II. .rtnnl.ive nhlt IRA NCAC 1C ul IR.
Q. YIN .1) (flan). __f_3_ __ MGl IIUU 017 TI,S l --
IU. \VA I Ell LONI.S (drplll): — -----
nllllllll ll �.2-
II. UISINIRCI"ION: .)11A ���� R'nlllllicknI
44
12. CASINO: Depth Uinlncicl of \V ri yhUl1. Mnlrl inl
,,< -
Iloot� It__ - - -
Iloln_
I0__—I"1.—___-.-_ Melhod
11. URUUI' I)rplll I �fNC If
Solo a— 1P . __ -- -----
i-l- - - •Mnluinl
Ft Irink I)imocicl Slot Size
"in
1win = -- Il— __in. III. _—.--
Ilolll--- Io-----
15. SANII/ORA\'t t PALV-: Site Mnlrl inl
I)rldl, __.
In__ II_
III,III--- VI.��-- --
Itnrll 1 o---
Ll)1711.LUIJ_51'I JSl l Intl
Sho\V 1li0e0loll mill dislnnce in miles Gu116a
Iwo Sink Roods or County Itonds. IucluJ le fond
11UIIIttcls And common fond nafllcs.-;-
QP
e LaaseaL ei
16. III MARKS — — tvliLl.
F. \ I DO III lit 11i• U ltl li VIA I1111S \VI'1 1, WAS CONS I IIIICIIIU RI ACCUIIUAIICII WI III 15A NCAC 2C,
1 NSI/uWI�AlUS,AIJUJIIAI ACUI'YUI'I1115I1LCOIII)IIASUCRIJI'IIUVIURD1U111LWELL OWII[R
OIJSUtllSl_U
vJ L�� ��.w 1 SlliNnl UIU! UP I'CItSUtJ cum i ItUCI IIJU 711E WELL
DA III
i n - h, N C
I)WrI IILV.1',r1:ll
"I,,�L --. t,,t;,ll1)• 1:1 nwul lsn(er Section 1636 Mill Service Crider - It.le R
7utr },i)!'4 1;'••• to III, lrinn vl rt r,,,, ..I '
C `;Jfn4 I$kl,Il,adr}��1919)i,71JJt21, ),Ilhhl :111 tin) s.

2'76100
AVELL C;UNS'I ItUC TIUN ltliiil;vi'W
J�m�s n,� -- l
14oilll Culolina - Urpalln,rnl of lievllunu,cutlnnd Holm al Itenuulccs - Ulvlslon of W nlct (panty - Chooud.vnlcr Ssc Uo11
\\El,l,CON lnncunt pr+InVII lAI,)Nnntr. lr I— r nom6 r cFn111"ICAil lurlll 01)(4
7
WE. IA. con IIIA('I MI C(InIrANY NAa1F. '' I ^571CIAl P,II nPIJ rF.Iln11U _�----
SIA IF. Writ(.-IINS [Hurt ION I'F.IIPIIIr-------
if n r dicnblc
it n IirnLlc
I. W p1,1, USE (Check Applicable Ill'\): Ilrsideillinl ('1.M11unicipnl/Public LI ludushial LI Agticultwnl
LI
M1louiloriug U Itecovriy l_I heal I' tiny \Vole( Infection LI Oilier U If Uther, List Use
Z. 'LL LUCnfopug,all,idlwil arlting
Ne:nil Cuuuly/h�dge 42r,Pr IiVnllcy UhAl l:lnl -41 e 'C1 - _ (dvrnpp,pll, it 1,1.
LnIllud
(Flied thine, tlinnbrn, .`.„JI. Subdivision, In111a, Zip G.Ir) -�iB f ilk( t5�-
dlwlgilude of well location
1. U l'.IL•�b��T�(1_S
(dr Rrrd11n11rn/lr^nA.l
AJlklIcss QC_ tQ Lnlitc'.gildc salncB:LlUI'SCl fapoglnphic nrgr
(died Inn;
UIULLIIat} IRO
(Sheri f„ prole Ilnl __ Lre/�-- ))��tll
m\+�y_\^L �1 ri 01 `b"l f(vw 10 formation I!c^cIiplion
`�"�"" $mle tin Code W
City m l it —_ - I p r
C..— ) ------ —"-'`fin —
MA throe nnnlha
I. nAIt ulul Lrn _1_121�--
5 101AI, PIT 1II.- -SOS.-'
b. tiorS WELL REPLACE EXIS1114U WELL/ YLS U No Its
1, S lA1 IC WA 1E12 I.IiVUL llclow 1 i11, aCnslug! _al___- _
(ll.r "." (r Abnvr l na nl Cn,lni)
1" f. Above Lend Sul rnce'
R. 1h1 hi- l'ASIN( IS _A •udia.
•1 I rlr•enrl I I ,.11r I ion1.. 7 .111 r.' r.
, civil(' 111 .Until.\\( rtt,, llll I5 M1I t`nc I II IC) 111^11 .11 �` '
0 Y Ii.I. 11 (flint). 1, v...._ _ - C+J
III. WA I Ell lotuFS (depth): —
LUCA-r-(vl4 Si I-J',11
Show di(ccllon and dislnncc In wile!' hen, '
,r,l r nl"wool _-V Iwi, 51nle hands of Gnmly konds. Include The load -
I I. IIISIIJI UCIIUtJp l WWright/It
--
I -
IZ. CASINO Ulnulclr1 ill Wright/It hlnlrlinl numb els and common tend ualnes.
I,cpllr� �,� ,. 52i,�J� i-- :a
lom�Q-/Di •• --,
Method �
M1tnlc inl �'
11. GRUUf' UcPlh 2a
�C,S C
elan, __ .1ri. It 2.� F s°as
h olu__- ll' 1'I rpthUimnclrl Slot Sire M1lnluinl \ ti u\�
IA. S1-gl.nlJ. On_ _ it( _ II( — co24 3y N
floe,_(.,--- 11` lit. — �\
lo_.._ Il__ in. 1/
Hem__ ✓ -
15. SANUIlillAV FL PACK: hhdr(Inl
lir11111 Sire
1 a__ 1 1.— ��
Ilom_ 171.
I"Imll_-1-u_-- - ---
1 un Ill nl IIY L1 n NI Yi1ll,Af 1us WIl 1, WAS CUhIS I Ill1U1JIU Ifl ACCOI2UAtH:e WI I II I5A IICAC 2C., WELL
COIJSIRUCIION SIALIb f4l)S,AIJUIlIA1AC01'YUP'1111SIRECOI21)IIASUUIEIIPIIOVIDEU101d/c11L' EL�ly—
SIUNAIUIUiUf l'jilt SUNCONStlW lIflU"11111WELL
lI,ric
Submit Iht1oilPllmtln llie" Ilkhln❑ of Al'nln (polity, CI auudlvnler Section, 1636 Mull Smite Ceder - ItnlrlRbtJC
17f,an-If36 !limit No. (91v) 711-312l, within 311 dnys. 0der1 IllV,

'SPELL C;UNSTRUC:TIUN IlEtiii“)
'R \�-)'\s _C\ CEnIIfICA-11oNF2UDU
iloitli Cmoliun - Dern Intent of linvhonnlco' mud Ilnluts1 Itesuulces - Division of Wale' Quality - Chouudwnl r Section
/�(
It ELL CON I IkACl IIII IINIIIYl11nM1 NAME Whit) =0 %1JJ r)- r�"li�
1,` n k U n _ r,IONF- r
wf.l,l, con IRACI WI COAIf AN 1'NADI F. �. ASSI�AIFU n't)I'ElUlllr
$IAIE tIELL GUNS IIIUI,'1IlIN fF.IINIIr -- if nlilicnblc
Ile dieslde
1. \t'F1.1, USII (Check Applicable Ilos): IlcsitIcnlinl I11---Mllllicipnl)1'ublic U IuiIlshinl LI Agticulltnsl U
Monde' iug U Itrcuccly LI Ileal lump \Vnlct Infection LI Wier U If Other, List Use
). WELL LUCA I IUtt,i fopoglnpl11sd1m1,1 sell
ing
Neatest lowm. \---
lolul)C_ Luling;
I m IIVnlicy L lat
yO-18)(Hu(check n,ngnlAr b"Q
(Cleel Hittite.rvmba•.Cz;::::•„bv. Subdividon. nllo.,7Ca) LnlltuJdluugilude of well Iucaliuu
/135113 -_ W{j.7c23-
3. h\kites 1: J vnp '--. .- _ -----
Lnliiu ^n•meiludc sowcc:Ul rckNl Irl npoglaphic n'� 1p
Adchcss r_kiia per'-'(— - )lllll,l_1I1f1 i.fJ_l1
Isat
(Surd m rinnle rin) I)LL, I1
y� , J 2Rgtx.Q= Prow lb Ppl ulaliu❑ Ilcsu ipliun
Lll O�l-_ --71I, Cod' D 10
Cill of lo,n $IOIC
I "__1.-- -
Air. c dr. I'Iur number
. 1. I)AINPRI! SULo-LC1J ----
5. I0IAl, UPI'I I1:
"_L-1_S'_----- -----
6. DOI'S NPLI• RPI'LACP ['XIS LINO \Milli:' lY'ESD 1NU i. ---------------_--
1. SfAIIC\1'ATPIll.RVISLitclul`t.r'It�IIAbovlelop ofrn.hep)
"I UE UI' CASINO IS - _ El Above I end Sot Wee'- --"
P. •Ire or nd"p iru"Indril .ltor brinn l."J nnbre lr9nhrl • _---__
.iliac b,.rtrldfnce nwi ISANCAC IC.011A. -_-
Mlil HUD UL'fIISl,----
-_
V. A 1 NII.
(Rl(pro.`u-.... — 1 IUN5Y1 jf I L
Ill. WAt iuNS (drplll): — — - ), �-
Show direcllon and dislnncc m mules Rom el I ut I
_ Auunnd \��— Iwo Stole hands of County Ponds. Includl ni I- /
12 i)I lI.N Fri JUIJ 1ypch ��. gl' Well ibicknr+s iI
i cI Mntrlinl numbers nlltl c0IIllllull Pond IGu m..1. + � -
12. CASItJO:
I linumlrr ut li ciy,�l-•.. t7
Iin_ �vC-- .:3
fa r n' I1.`s� S1Y.L L
f nn l _ ___ C •`
I o- I"l—
hmnEl Method
11. (iIUIUI Urplh tin clinlclrP �23 -:.,-)AS-
H.
El
"loin 1:1. - -_— - r� / --- O
glom _Pool-- _- ..-_ - - Mnluinl i / 0
Muncie; Slot Sizc
S' !l! IaJ Itrplll in. — I
I„ Ill ___iu. in. _ i-
haul_ _ I i.__iu. _ _
15. SAll Ulli IIAV PL PACK' Site Linlrl lnl
l)rplh
hole lo__ II.-- —
Ilolll 70— Et __
276097
16. REMARKS:
IDO III RLOY lilt _1kIrY IIIIS \fEI I• WAS CUNSIRtlCIPN IN ACCORDANCE W1111 I5A IICAc 2C, WELL 3
' COOSIJIUC I ION 5IAIII)I DS, AND-IIIA I A COPY UI''11115 RECORD DAS DERI PROVIDED 101IIC WELL OWNER J
- CD
� � UA1 B
,------
1li SIUNAIUIII!Ufl'PRSUIJCUIJSIItUC11NU111RWPLL
L--GIJ.wILU+eu1P=I+pu,{�� OW -I RRV.U7f20I11
� o Ilie lticlllon of 11'nlrr Quality, GI Section, 16361\1111 Service Colter - Ilnlelgll, lL
rp961 i",�iNl+t �ICI1919) i33-3121, ullltiit 311 days.
l

276095
11rl;LL CONS I'I(UC'1IUN IU CO lU:
S t^l'14 ri^ CF,III IfIG'l1UN�� oY
Notlh Cntolina - Drparintent of larvltulullcul mil tlnlwal ItcauulCC%- Uivlsluu of Writer Quality Ur0uodwn1et S•_diun
NI ELL CNN I IlACI 1)11 IINI)IVIIIIUL) NAME lrrlup s. CI 4
sy� i1e� 11Tn — - —
nlour a lg�l ti
s Q,L cuN n[nclun COMPANY NAME r
AS SOCU-I a", WC) ra.I[MI N, .___----
SIAIF,teEl.I.CONS IPuri ion fF,llnlllN_ --- if nr licnblc
iI n dicnblc
I, R'FLI. USE (Check Applicable Iloa): Residculial M Mwricipnl/Public U Indus!' inl 1] Agricullulal U
Mouilul lug 11 Itrcuvcty 1_I Ilea! I'ungl \Vold Injection CI Ulher U If (idler, list Use
—___-----
'lopogi npliic/I,nlld ' clliit
Ullidge I. opc I -I Vn Bey U1In1
ichrrk nrpn.p,Inrr liar)
LnllludJlon iludc,of well location
R I'n
y✓`IZ' 3U/`
ldrp, <rJnJ nntr 1r-^,r,t, )
Lnliiuh.jHuuilude soulce:L I[11'SL1l npogl nphic ur9p
Ichrcl I.•i
Lll UIUI-I,INU LQ[i
1'onnnlio❑ Ucsuipliun
j_ WIWI.LUCA11UN: County_Pcr,ke
Ncnt csI- 1 owu:�li�-h\�---- -
'Q"-t"ne,__ _L)1 nv. Sabdivinhm, lot Nu,71p G*Ir)
(Slrr rl Name. 1! imM1a n. L•. ....... aLu1
iSorel of floule Iln.)
Pax AD:bnill_ VI —
City m Innn
stole Zip Code
). Uw111U1
AddlcSs
(- ).-- -"
Alf II ualr • Bone number
DAIF Dllli Lr.Ur8-Q3 -
6. I IAIW111.
111'iiL'l1_7AS F.- ,�Irt)y):111 Sii.S U ilU cU
(. ItttISS tt'P.I,I.IU'li,At F. i'ni SI •1•-� I
1. S IAIII; 1VA1-Fit I.F1'IiL Pettily lap r Ivr, I Abnvr 1tip of r-n•i^) I I _
it I-. Above Load SuiIiree'
• Ivp at nd„r IrrmLid r,1 .Vn, LAnn 6nJ .,n Lcr ugnl, rr •
.alma Inarcn,drnrt.•IdrNAri AC IC UIIII.
/I°.SI_[_,
0 VIPI.D rl")' _JD.-- ----_-- .
Ill. WA I IU( ZUNLS (depth): ___ -- —
Arnouul.._ _
II. UISINIIlC1ION: I)Ir \NJl lhickncas
i j. CASINO:Inplh I I)imnclrl at Wright/1'1. Mnlrt inl
.10 ' D _ ll_ia., S__ SUC) 1 -?��—
Float__ -
Ilam—_ Il...- "" -
I'Imn_ 'I°---- _.-. Method
hinlctinl
11. li IICIUI: Il plh I I � _ tQ SUL.E
- PL_
haw__ -_. to Uinmcicl Slat Sire --- Mnlcninl
H. SCI'.I?Pfl Ucplll II III. In.
Ilol'I__ __ - -- 1.1 _in. _ _ in. —_---
15. SANN/1111AVl'I. I'ACF(: Mid r,lnl
;Milli Sire
rv_—
E1ain11n_ u1'-ri.—___ _--
—
16. IUuHARKS:
I,DII nl RrRS CEI111FFt
CNSIIlUC1101151Ali0l
Ili l'�I
LVCAIIRN-Sr-ULII ;
show direction nlltl distance In miles flow rthlensl ,
Iwo S ale Rands or Couuly Ronda. Include l_ ion f
numb -is mill cowman load names.
h 0-
r.
n
T
Al 1111S wrl 1, WAS CONS I MICA 1112 III ACCOIU)AIICIt WI 111 15A NCAC 2C, WFII.
n\SlDS, AN 1111/1I A COPY OI''11115 RECORD IIAS UCGFI 1'IlUVIDLlD IU 111C WELL UWUFR
_ -L DAIR
/ Y SIUNAIURI OF I'19&SUN CU11511tuc11NU"IIIR WELL
h,rtu
rD1
Sulnnll Ibt all Innl to Ih nlvhlnn 0111'nlrr 111ndlly, CrnmNilvnler Section, 1636 Mall Service Culler - ItalrlRNC
R LIr.'[n111LUrttAiiIICpf1u._019) 113.3/11, wltldn 311 tiny,. UWrI REV.
G
ASH. iC,CI 'CNAL OFFICE

WELL CUNS 1 itUC'1'1UN 1U5Ciii:1;
t1o1l11 Cm Ohm - Urpallnlcut of Envlruunten( nut! Nnlind Ilesuurccn - Division of W nlei ()wilily - tlioin d nI it Sr+dlII h� Oy
Inl �`\
o E61.C(INIMCI OD (INDIVIDUAL) NAPI,,F,�,iPt���1_�� 1 YIIONP, a (�_1 �-1"�cFrl
uv NAME _M ie �-^� dC 11 ,.,q -
1cE1,h CIINIIIACII/Il Cllitii,\..- ASS() CI Al E114VI) EEI(MI III -
5 I A IE. IC YLLCIINSIIIIIelloN PE.IIAII in___.__.-------- Cif njgrlicn)rr
II n tlicablc
I WI71.1, ()SF (Chrtk Applicable Ilea)' Itcsidcutinl I11----Muidpnl/1'uLlic Li Iudnsllinl I I Agtict_11:oat U
Mouiloting U Itrcovcly LI Ilcal I'tn it, 1Vnlrr Infection LI Ulllcr L1 IfUlhcr, List Uric
'fopopin116iciLni d Srlliop
7. flcai1..1owil (1N � """�� Ullidga I.ISlopc I1W-nllry UI'Inl
�f� 11 County-rLeiw-�P-�'- ( isl nppngnlnrt ilr
tJ c m c sI I o,v n L(hJf 'a-4`?:-.. -..--_
-Q>0 iVa _ _ __ - . - . -- -- I nliluddluuplitude of well Iocalinn
)
IunrUer •, i't �..._. hv, Sulnli vision. lot Nn. 71p Cnlr) II// LL l '1 p 3 �_ w/�3�. �,
I$beel tln�ngt ice- -
1. I/W111111' 1^ t� __lAc ��- __-___— — Lnlilud^/lnneilude Suurce:U' ll'-nwiii glnpliic m. yl
Kk (check M.l
AalJlcss �%.,Shrrrl RU-QeI I.)RILLIIJU LIIU
(Suer' pi llmile Nn1 L� 1^ I)I'hl)�
SAcAXnS_ flow Io 1'onnnlion Description
$Inge 71p Cole 5 , )G, — --
CBynr Imvr -
, e I"------ —- - 30 ' fr1 L------
Ain rrlr 1'Lr11 is i)jj 3u -- 3os mr=rb. --
. A. DA11i URII Lf.UL23-
(. POPS W IWl. RBPLAUp, FXIS IINU WF.I.i YES U NU I(�I"
7. SFA-1ICWAlilt 1.EVII.LUcIow(llopofCwligve c___0Ift of _,i"e F. -
I' F. Mono. 1. and Sullhce•
P. l UI' et"CAS CASINO _ ./_---_ hind intrar ,enuhn•
• I.p et e.dnr Irr niLnitd dhn t�110�
, ululte In •rcnttl•ine n1IL 15A NUM' 2C .011A.
ME111UD 01'111S f
o, 1 1.D WWI)! -_ __ _
Ill. R'A Il Il Lours(Jrplh): _ -- --- —
I,OcALIUN 51;_I:IC11
_ Shaw ditcdlan and dislnncc In lnilcs ('coin nl I. i 1
ao _),I 1Li ef-5_ AmountIis _ wn Iwo Slnle Itonds nt County Rnnds. Include 111 triad
II. I11SIN1I(CflliN.l r -�y(' - 4vnll l6ickrrcve
12. CASING: hV19. Mnlclinl ❑ombe's nod common loud moon. co
�hlinrncicr of AA'rlp, Ii��
l it r 11. r24 __T' �- - c-7
Front pl l-n y1 -_--
Ilon, 1 n_� I I--___ —
pinlctinl Method
13. (AMU I.! Ikplh e S LC-C_
Flom �k„'-hI 11PCLr�e --i"�`--
I'tom - _____ 1o__ it__ _.—
Ilimncicl Slot Site MnICII01
14. SCnrpIJ hcplll In.
iti
Ilom_---.lo__--
II it!.
15. SANUIUItAVI'L PACK!girt Mnlrtlnl
Drplh
276092
IG. ItIMAItKS:-..
II (IH9j11'dlltylC(I}IIY'Y\-
Mltll(-1tUIVSI (Ill
/ �iIEIII
{{,T,
A rEvEn7 I.rvV�
fr
0 —
fe f13hi"
/
IA I I I IIS Wp(1, WAS nil IS I 1(11C1.111)111 ACCUItUAI ICh WIl 11 I5A I ICAO 7C, WELLRUS, AIJU 1I IA f A COPY ON I IIIS RECORD I(AS i 1 !- _'IIOVIDED 10111e WELL OWI1EIt
_ UAIE
II� SIUIIAI UI(I! UI' PERSON COI ISI RUCI1NU 111L WELL
udl lit I le Illrhlnn ui IS'nlrr IpuJlly, CrnuudlrnlcY Section, 1636 Mill Service Ce'Wrl !WV.0177t11111
Ito. (91 ) 1J3-1I21, ollhhl 311 toys.

276039
1VILL CONSTRUCTION RI;('OItI)
hall( I ((HI( I)r1 iiIii nl nl I.uviruuwcol and Maui al Ikennwn s - I )ivi<irnl of \',-: Iva ()nifty - (ionndwalcr Section
w111 r n^.Iry wit (lNIll\I❑V:\L)NAME II 1111--_-._[._��� (�� J (�,7 _ CF'It 1111CA'I KM M_ -
Illit rrl`:IR)t IIIIt11ID11'\NVNANIl. CLeRok- L�-�E'-'t-,br�ltLl07 .. _ 1'I II IN N l'S•41
4:I.'(1 nlll IIIMIUII II17NI'EI011I#___. __- ASS(11'IAII II\c1)1'I((mIIN
lit ariditnbl,rl (il :gq,liLnblrl
Ak 1 I I 11;1: (1'hcd. tyrplicablc Ilu1), ReSitlaulialiG 1\lunicillal/I'uhlic I 1 Irvin -at i:d I 1 Agiicuhutal ❑
`.I.•n Ib •1 iu,- I I'.r•I I,I rl1' I I Heal l'ungl AValet Injection U I)Ihcl 1 1 II I)IIi i. 1 ki 11<I--.-___ _-- -
\\ I 1 1 1111 r\ 111 (li /
>yG_
I Lurid Iron 721�Jf�/A� lamlV'� )l lk -P.O R'(_: _ nnnnnily. tinlniivi,:i,,n, I nl Nu.• 79p Cudrl
:, I II.I: �.lr 11'kv �'�Uf=j�d�� J r_%R..•..471.3
1 `ar•,I,•1 `:.mr Nat C
�,,„ p�.y C �r�
i1, ,1 Ikon st 711, rode
I`ft. Jai'- `{ a 1
I I',\I1' 1)1,11111) ((_--
lul:\I HUH It
//,
I. I n 11 S \\-I-I I Rill:\1 1' f RISII N(J \Vt.LI.') 1'I?S ( 1 NI) itt
1 ':I A 1 I(' VA'Al I R 1 1 A1..I. Below I,'p nP (':Isin P, ._ ,C..
/ IIr•.r .•:.. it Abner
I''l' 1)I (•A SIN(.. IL; ( _ 1-1 Abnvc Load Sul lhcc'
• I !a. :,l rvdn❑ Irnu hr„Ird xl'm Irrlm. !nod rminre require'
,:nIen,r br nrr,.rdn n, 'Inr 15.\ NC:\(' H' .1)1 IR.
P 11'I I)Ippn1IP. ff __ NII!111000RPkS'(
In \\'.\ 1 VP L()NPS Ill l•lhp.
II 1)1'01411,(•1114J 1,p
11 1- \ HIV 1
11, 1'1 LIAIt1.S
1 U11:111 1 1 ll't I It1111"y�
4-14-114
.IaTnn(17 +?-i',u 1 .Iki;I�hr Ih1
c'CYI 1 \
.71p1411N.Pi''Ur 92191''1
-t l 1221, %I 41111 311 tln 's.
11
I)ialnrlrl Slol Sir('
I 1
It
(
-- 1
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I)japcicr nt AVc ll/Il Nail al
Ialclinl b1,11« l
SI7C
N1nlclinl
I11,0)'1;1 1c/I;uRI setting
1 II'i•il'c I Slnpc L1\':llcy CJllal
Ir1„rlanpl prial-bn.)
1 :niftily lonitlulc or well localioit
I,L.L .r.'Imu n r Idq
I alilull-Irrnriln,l• amI .c'1 It it SI 1I oh/In:grbic Mall
I,n. )
1)II'1II DRILLINQ3.O;
I Will In Pal nation Vesta i plio❑
%i _A (17/41 ..
_ GA)I1-
0r /E
I&?'
I ()CA 1 1(71\1 SKLTCII
Slimy dilc<iirrn nn I distance in miles limn al lend
taro Slate Rand': nr County Rands. Include the watt
umnllr: :mil 11,111111011 11111,1 nllHIl'S.
0
-rtil`� S L
co se,
r
VI IIIIS WI'I.1 WAS(()tJSPIUH' IIURN A( ('I)Il)ACI I gull 1sAInA(' 2( \A'1:1.I.
I)S, AND I jA I A COPY (2I IIIIS I'I )JEl) IIAS111'1111'1H11'II)I'l) 11111111%11,I.OWM:it
5111NA a II or I'I'Itsuw ('( Ipf'r it lc l INI i'1 I II' \VI I 1
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Di‘ kiwi of 1\?Ilex ()wilily, (aoundlvaler Serliuu, 1(•)a (`tail Si, Ire fritter - I1alel{(h, Nl'
(17/21101

fir
WELL CONSTRUCTION RECORD
I I441111 1 - j�/
I I I%In11A1) NANII' (prinll�%`�-�R/ ` 0,0 cbS 1=EICIIFICAIIONY C15
276038
u olina I )clmlhucul of linvirlitinlenl mid Natural Rcsuulces Division of Rh 'a'1 rituality - Groundwater Section
\\Ill,ul\lll\I IIIIl( l '. ._''-- Il...-V1.__.._-I�
1 I , INl It \t 11111111'II',\N\ N ANI'. Ct Qke1 i1.. i/ kvol....IoIIONE
\I L._
\II ''111 ( (INS IIII( I ION I'11111I It/ ASSO('IA7111\%1)PI:11?IIIH
lit a(,Iaial6kl (if ;wiica)lr)
I. \VFI I, 11;1i It 'heck Applicable llos, Residential VAlunicip:ll/Public CI hhr:hill CI Agricullulnl ❑
l.14.44114iliuv IJ Ite. ,ikrly ❑ Ilea' fungi Walet Injection [J Olbcr 1l III Whet, I isl Use
I•I I. I it':\ I IIJrI
r!, abst 1 M O /YI tali_1. _ CollnlyetgA.
y 1 Hmyo Humber: Subdivision, 1-0 Nn.. Zip ('u.u)
11WN11Z 7T?omA5_ 1—I14/k1
l' 1ne rip ) pp
l Wyk .niil pa''n' I Zip Cole
1CCIp
I001' r hn,2 n 1111l1n'I
d IIA II'. DRI I 1 11)-p3---
I111A1 PEN 1I� SCIci_------—
1: In,I-C\\'I'I I. IkFI'I ACE I iXIS11NG WELL/ YI;S El Ni EY -.._---
I ,1111 WA II'lt I I. VIEI. Elclo\v'fop u[Casing. 4_7_0 ...-I1
(we if Above top
1111' (`I' CASING I': J_ _ LI'. Above laud Surlarc.r
' Ina tut,. your Ir, mluni.41 I, Ilur bettor Inu,l eurince renulrer
:n l:uu, In nrryn l lnylrr`'116 15A NCAU 1(' .0119.
'1 lll'1 D11•pnl) ) c2.,-NWI1101)OE I S'I'-%%1 ...
)
In V: ;vIlly /4NIlS11 IrpIh Y,_ __9,0C)
1tippgriwiticil.antl setting
LIltblue fellope ❑Valley ❑flit
I,1ecl nppraplinlc box)
1 Milli( C'�lonrbnude t %v]ei
e5-l�lupe liioti r
tO
nl p1 I ides/eeannls)
alilmic Lm)rl 11,. c urk1'I I(il'SCJ lopogrupllic neap
(check btu.)
WA: 1 I1 )RI[ LINO 1 Q.1
111,111 111 Vin nation ',ascription
-5c)__.
--.St)
__/:z2 —_5c) S _
( CLi�C)4N'Q Amount -_/oo_PP:i-r4_
I I I I`: NI I "I InN'I vp�•
1i , A(MR y 1VallThickucss
nrlgh I)inloc1c11 ur Wcighl/I1 NInlrliul
I win_ 141 11.
it 4 F.1 It% 1 !,rill NinIrrinl nhlul„ a
11 T1 C) 1o,-)0 11,Oe -c qC..- 5kn✓1r _
11„ln _ In I
11 'l( 1,1'1' Fl Ili lnb I)ian,cici SIul SFc 1,111'rii:d
I WI n In I I 111. 111.
I, I, 'rillICIPAVI-I I•\1 I,. ...__....
11r-1011 Sac Malclial
I nun In I t
I Intl, In II...__._._-_.-
Di PI PI t\IiAI'I'a
I t1,I II1 r'1 T\rhl P.Tirk`ratl1 11IIS Vt'll1
(1 r1N :I Vlh 1[1111 bIA��Yr)VAyl US•ANI) III/
lr_
1
SI
A HIRE
I_I)C:\1ION SKLiICll
Shn\\ dilc%lion and dislancc in miles From al Iei sl
I\vo Stair P1lad: nr Comity Roads. Include the road
ninolici s :nIJ r„Inmon fl,ad Ilai cs.
0
L
r—
r—
rw-R rzr Pb
WAS CONS.' RID "I f l) IN A('('ORDAFfl T WI I I I I cA NCA(' 2C, WEI.I.
A COPY OF •1.I.j IS RB UItj) IIAS 11111 11 Ell' 0.1ID1 D 11) 1IIE WELL OWNIiIt
DALE
'i:itso
IINti'IIII U'PI I.
Suhnul Ihr u'iginnl , Ibe
6Rc:2 ft kMS[L$•�1U41C/14u.111'1I
1c `,itIOFFICE
Division of \\'ale%Qunllly, Grunndnaler SVCIIiIII, 16(6 Mall Srr'Ice CenterI RBVgh, NC
211U1
111-1221, within JII da)s.

276104
11'ELL CUNS I•IIUC'llUN IUslAji::;
Cro i Ir IGl IOU ro'14D4
1Jo1111 Cni&ion - Ui ntlwcol of linvlantnicol nod fl canal Reso1urcesl Division
o W nlcr (Quality - Chown'writ)err1S$.lion
tI EI,L CSINIIIAC"11111 rIN DII'IOIIAI,I NAP,E,�1'P'�r,P-CSAfd—+- n _--"--"----_"-
writ. Cur+ IItACI O II COPIrANY NAMECY1t11 — -
ASSVCIA-I ElrWI)'icoble.11P111�-__-------
51 AIE Irf 1.l, Cllrl$IIIII(-I ION 1'F,IUIII0-_—.-----
il n rl
il n !nuttily
I, WEI.I, USE (Check Applicable pox): Residential Id' MunicIpaln' 111llc U 11ld!100'11 I1 AgliculIW nl U
Mmliloliug U Iiccuvcly LI Ilcnl I'mop \Vnlct Injection LI Ulher U If Uihcr, List Use
'fopnpinpll{c/I•nllll ^rltilI r
). V.'at&" CA11UtJ: l;ouuly (11PCOi�r� Ullidgc I_ISlnpc I IVnllry
Ul lnl
Ich�rA nlgmgaln4 lint)
N\ber.-__ " -- Lntlluddluugilude of well location
�-`—_.__h.. SnFJi.iep,n, l�,l Ila., 71p Code) S' 02(hi6 kli4i 121•3
ICbccl Nninq Number., Cot: .^ �. -nndQ
' Z IilrprteJndnntr Je--
1. 111VNHIl_L3a Sr s\sa__ Lnlilu :rl,ut¢ilmIC SOWCC: felled, l hl npnglnphiC m'p
Address %Y�`e✓1L_ l4r( X`1 _ 11111I,LIrJc; LUU
l ;prcl (it R- I1nJ matt
N�', r,Uo,Ie -- 10 1'olmnlionUcsctiplion
1?1Ul /; I rum
Chy of loon soon 7_ Code O iD `
I )"-- o - — In
An, cnIr I hoot
tel
4, I)A111 1)IIII.L1111_62ii.9_Q3--
5 lUEALUEl'ilL----SII �_-
(. I) Jl'S \ IiIEI P.IiI'I,ACP, Ii.XISI ItJll \\'I[LI;7 YES U rPIU 1lll
7. SI-AIle\CA1ER LEVEL llclow"fopruu(A1"ri�.rn �i"t.l----_----
tll,c--__----
P I-. Above I.mol Sullnee•
A. •Ir rIc•d„r lrn,,lnubd dro, brlonbuil 'mint lr9ulnr• �—"--_— _
r n,n
no try gym): _ 1---- 1' _ 61111lIUU U1^f RSI' L--- -----.--0
U. 1'll.l.la (gym): 1--- --- W
IV(nI-1UIJ_SYLJC!I
111, \VA 11in Z.UNI S (drptL): -- nl Ira:r
Show 'Unction nod distant In miles II1ll
Auunnd V Iwo Slide Rolls or Could). Roods. Illclu(fe�lte Inns
II. UISINI"I'.CIIUN:T)1'cb-_�5�--R'nll ihickurs5
R. CASINO: Uinulclrr of W rip)1Upl. Hairdo; 'anoints nlnl common 'owl llait1c9.
Ilrplh l — 7`
I"lonLQ— to--I'1. LA$ T
flow 7n IL_ -- \
.Io " rt. _._- -Mellon)Ptnn+- hla inl
13. Glum f: I)rplh _ereSS 7f
1.iPIP_ _ .I ii — i iUinlnrlcl San SimInlrlinl
1d. SCILFI1N. Nrpill in.
fl
ill
houl_I"- - — - - in.
Io-- I1.---il!.
Ilonl----- ---
15. SANl11URAVFI, PACK: Sire Mnlydnl
I)rplh
Ilnnl_ __Io_ --
It_ --
hmn—
ItHiIC. RPMARKS:
AIJU111A1'ACUI'YUPIIIISRECUIIUIIASBEENPR'1U111EµELLU\1711ER
litty Itroy"i f.P,llf i fLLnl 1IIIS MI 1, WAS CMIS I101CI ItU 10 ACCORDANCE WI111II 15 I5A NCAC 2C, WELL
CONS nluC I ION s t npn�'i�uG, ��-
_ DA111
' SIUtIAIUIW01- I'IULSUIJ (JAM 11w el iIO 111E WELL nu
Ull r ItEV.1',Nt: 1
Subndl Olt ul Won' to Mc I31 3121 al chill l 1)1111111y, Crounthsnler Section,I636 Mull Service t
Iv 7311221,IIWIN111dnp9.
1�11Pfl.R',�(r)<Et'S@E dAI.

276867
WELL CONSTRUCTION RECORD
Nod h Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL)NAME(prim)
SHANE WALKER CERTIFICATIONS 2415
w'ELI. CONTRACTOR CIIM PANYSAME
YADKIN WELL CO., INC. PHONE $ (336) 468-440
STATE. WELL. CONSTRUCTION PERMITS ASSOCIATED WQ PERMITS
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery ❑ Heat Pump Water injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest "Down: MIIP.PHY
CEDAR MTN RD.
County CHEROKEE
(Street Name, Nmnhcrs, Community, Subdivision, I,ol No., Zip Code)
3, OWNER: MATT BRYDEBELL
Address P.O. BOX 1475
(Street or Rome No.)
MURPHY NC
25906
City or Town State Zip Code
( 828 )- 644-5681
Area code- ('hone munhcr
4. DATE DRILLED 07-22-2003
5. TOTAL DEPTH: 140'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO RI
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1' FT. Above Land Surfaces
*Top of caging terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .a118.
9. YIELD (gpm): 30 METHOD OF TEST AIR
10. WATER ZONES (depth): 73'-75'
II. DISINFECTION: Type CHLORINE Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From +1. To 29' Ft. 61(8" SDR21 PVC
From To - FL
From To Et.
GROUT: Depth Material Method
From 0' To 20' Ft. CEMENT GRAVITY
From Tn Ft.
13
14
15
SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
SAND/GRAVEL PACK:
Depth Size
From_.. To ---_---- Ft.
Front To Ft.
Slot Size
in.
in.
Material
Material
16. REMARKS:
Topographic/Land setting
❑Ridge RI Slope ❑Valley ❑flat
(check appropriate box)
Latitude/longitude of well location
Idegees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From _—�--To Formation Description
0' TO 24' SOIL
24' TO 73' MED TO HARD GRAY
73' TO 75' FELL
75' TO 94' MED GRAY GRANITE
94' TO 97' SOFT BLUISH GRAY
9T TO 140' MED GRAY GRANITE
O --
W
C
BIT SIWS 30098-26 BIT SIZE 8.082
LOCATION SKETCH ut -
Show direction and distance in miles from a11yylssIeast
two State Roads or County Roads. Include tl»roacE
numbers and common road names.
O
N
r`%
/NIrA7 p�D
0
r \ I DO IIFPI BY zi RTTFF" -IIAT THIS WELL WAS CONSTRIJCT'E.D IN ACCORDANCE WIT II I5A NCAC 2C, WELL
- I ARI�S,4AND TtIAT A POIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
I az-03
f� CONN I RIICIIONS4�&tylp
<r-- I
J U'
SIGNATURE OF PERSON CONSTRUCTING TLIE WELL
DATE
Submit the original to tle Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
7b49=1636:I'fipneTlln. (91r6) 733-3221, within 30 days. GW-1 REV. 07/2001

sa
276866
WELL CONSTRUCTION RECORD
`gin II (•arnhnn - I)r1'mtncnl of Environment and Natural Resources - Division of Water Quality - Groundwater Section
VA11 LII)NI12VLion (INDIVI11tFAI.)NAME (print) Shane- uoQ dicer CERTIFICATION d atit.5
VAr 1_r1I) II( V(I('n COMPANY NAplp; dkI well. _co PHONE a 13it '/&Y- VIVO
S I.All- Vt I:I.I. CONS( MI"! ION I'I RNIII# ASSOC! VI EU WO 1'F.12VIIT0
1dnp,Iicablc) (if applicable)
I AVI11 I. I ISII {Check Applicable 'lox): Residential Mtlllicipal/Public ❑ Industrial ❑ Agricultural 0
1onitoi ❑ Re -awry ❑ Heat Pump \Valor Injection ❑
2 VA'I.l I. LOCH -I ION:
Neatest I n- (rut rphti Count) Q�� ,wee
Shrei Vunm_ Nwul c: s. (bm:nu/n(ily. Subdivision. Lot Nn.. 7ip ('-(1)
I )`)H NR: Sect --lire en
I----- --- . .
A digs, 2 fe -1 t CQmp Cek
Si, pet o, Houle fh,.l
Sty /ip Coils
1`1(). )1V(j 7713—
\i It I, -Ph n, win( ct
I 'MI PIRII.I.I'D 7-Z)-63
5. 1(1lAt.I)El'-Ili 300
h inms WFI.I. RI PLACE EAISPING WELL 7 YES LI NO ❑
7 \l I( \V'ATIIR. LEVEL L3clow lop of Casing: JP_PI
(use "1-" if Abnvc fop of Casing)
S 10r Or CASIN(i IS _I 1I'_ Above I.and Surface'
•Top of casing lir ni inated atfor below land surface requires a
n Luke in arc -lance itli 15A NCA(. 2C .0118. q
'). 111'I.D(gpinL (� N1I LII OOFTES lit/ r
HP AVAIIR/I)NL:S(depth): I3?-137 , 1g-,17?
II 1)ISINF1 (IION _"I)pc Amount
I.'_ ( AS] N(i. Wall 'Ihickncss
.}I I ):prh f)i:under or \A rielll'l l 5I ucria.l
1 tHill! I l•8 Y rt.G' /-15 SQK--tl _ PVC
1 Inn) -In II.
P HIM I n (-t.
I l (1rO111I krill :N11te1ial NIellpiIl
I lull) Q to 00 FLf Port MO( HANG /
I nun, I(1 II.- --_ Atilt ear
I m PI' I . I'eplh I)icineter Slot S'zc 61.alcl iel
I nun in I . in. in.
I nun l o I I. in. 1n.
6. SAi:1)G KAA'Ill. I'A('K:
I)rh�h
I rum li
Ilan
16 171-\I,`.RKS
Size Material
II.
li
Other CI If Other, List Use
4AN —770
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check approprialc host
all tudeiIongitudc of well location
( )cti ccshuin, ics secom10
1 :muck. lend ud sou: ce.DO'S❑Topographic mat;
(chcck has)
1 )11'l ll DRILLING LOG
76 Fur Um Description
lll37( r_i?Jt
✓o- aT
-179 - -y4 So
JCr14t 7/jtf-1. 5/ 2 < c3i OFF
3oolcrrot4 6
LOCATION SKIl1CII c-_ '..
Slorc direction and distance in miles Ic:em1 v Eeasi
I',vn Clalc I'nads or County Ronds. Inds th iobd
nnolhr;e and cplmnon road names. 01
veroij Peel-ty Jarci �rgnl
TT fl ill f 1 f3V'-FT ILI IP1 l ITAT 1111S WELL WAS CONSTRUCTED IN ACCORDANCE WI1'II I5A NC AC 2C WELL
CONS IRL(`I:R)IIj S,Y'A DARDS, AND 1'IIAL Ar'OPY OF l FIIS RECORD IIAS BEEN PROVIDED TOHE WELL OWNER
SIGNATURE ()I. pF.RS(R'l (':) ]5 FR° '(:1aNG I!'I' VVII 1 DALE
Submit Ili nri2inal Io the Disisian of \Cater Quality, Geound\,alctr So. bun. ;(th plait Sri ire (enlrr - Raleigh, NC
27:64NJ-1616 I'b::nl No. 1')17) 733-3221, within 3(1 days. GW-I REV. 07/2001

L-.
WELL CONSTRUC TlON RECORD
North Carolina - Department of Environtnent and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION 3295
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
276865
WELT. CONTRACTOR COrIPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PEONS H 1828) 837-8008
STATE WELL CONSTRUCTION PERMIT,/ ASSOCIATED WO PERMIT,/
(if applicable) (ifapplieable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public ❑ Industrial D Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ANDREWS
2266 FAIRVIEW RD
(Street Name, Numbers, I lommunity, Subdivision, Ina No., Zip Code)
County CHEROKEE
3. OWNER: JOEAFONSO
Address P.O. BOX 488
(Street or Route No.)
ANDREWS, NC 28901
('itv or Titan State Zip Code
( 828 )_ 321-4855
Area rode- Phone number
4 DATE DRILLED 07-16-2003
5. TOTAL DEPTH: 405
6_ DOES WELL REPLACE, EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 40 FT.
(t lse "4" if Above Top of Casing)
S. TOP OE CASING IS 1 FT. Above Land Surface'
*1 op of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C .a118.
9. YIELD (grim): 2 METHOD OF TEST AIR
10. WATER ZONES (depth): 100', 300'
I . DISfNEECION: Type CHLORINE
Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 Tn 56 Ft. 6 1/8" SDR 21 PVC
Iron) _ To Et.
From To Et.
13. GROUT: Depth Material Method
From 0 To 20 Ft. CEMENT GRAVITY
From To Ft.
14. SCREEN: Detail Diameter Slot Size Material
Prom To Et. in. in.
Front To Ft. in. in. ---- _
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To _-_-- Ft.
'l'opographic/Land setting
DRidge ®Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(drpreesimi nu tesjseconda)
Latituddlongitudc source:OGPSOTopographic map
(check hox)
DEPTH DRILLING LOG
From To Formation Description
0' TO 45' RED CLAY
45' TO 56' MARBLE
56' TO 405' GRANITE
w
L
C
r—
v
LOCATION SKETCH ` Show direction and distance in miles from aast
two Stale Roads or County Roads. Include thgoad,
- _
numbers and common road names. —
fV r.
16_RENIARKS:
1' 1)0 HEREBY BY ('EIt 1IFY li L F 1111S WELL WAS CONSTRUCTED IN ACCORDANCE WI III 15A NCAC 2C, WELL
-TONSTRIIt. I IDNSTANDARDS, AND TIIAT A OPY OF THI RECORIHIAS BEEN PROVIDED 10 1116 WELL OWNER
i NS'
SIGNAL
SON C IPoOI%TING'f11E WELL
-y i6 i)3
DATE
1
Submit the of igitral to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636. Phone No. [phone], within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
276863
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
CERTIFICATION 13295
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC.
PRONE #
[phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring ❑ Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: ANDREWS
County CHEROKEE
PISGAH ROAD
(Strut Nmnc. Numbcrs. (Community, Subdivision, for Na. Zip Codr)
3, OWNER: ROY SARGENT
Address P.O. BOX 1149
(Strum or Route No.)
ANDREWS NC
28901
City nr Town Stale Zip Code
( 828 )- 321-4442
Arca cork- ('hone number
4. DATE DRILLED 07-14-2003
5. TOTAL DEPTH: 705
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top of Casing: 140 FT.
(Use "+" if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated 1Uor below land surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 5 METHOD OF TEST AIR
10. WATER ZONES (depth): 280', 620'
Topographic/Land setting
❑Ridge ®Slope ❑Valley ❑Flat
(check appropriate hox)
Latitude/longitude of well location
t dcgrecshminutc s/scamds)
Latitude/longitude source:❑GPSOTopographic map
(check box)
_DEPTH DRILLING LOG
From To Formation Description
0' TO 40' RED CLAY
40' TO 705' GRANITE
11. DISINFECTION:'(}Tc CHLORINE
12. CASING:
From 0
Depth Diameter
To 40 -_ FL 6 1/8"
From To Ft.
From To Ft.
13. GROUT: Depth Material
From 0 To 20 Et. CEMENT
Amount 100 PPM
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
Method
GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Et.
Front To Ft.
Material
Material
16.REMARKS:
W
L
r
LOCATION SKETCH ry
Show direction and distance in miles from at IA
two State Roads or County Roads. Include thermic'
numbers and common road names. —'
-77
O
N
PISGAH
— ---t 390-4tE.RE.HY-CCRTJFY-klAT THIS WELL WAS CONS I RIJC1 ED IN ACCORDANCE WI III 15A NCAC 2C, WELL
� 'CONS 1 RUC'FION,1riANN,A$US, AND TIIA'F y>gCOPY OF lIJ1S 1RECDRI IAS BEEN PROVIDED TOTIIE WELL OWNER
SIGNkfURE 0
ERSONT'ONSI
7-1y-2ot)"�
LING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
21699-1636-Phone Nut [phone], within 30 days. G W-1 REV. 07/2001
c;'

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section /'
/n� ,
WELL CONTRACTOR (INDIVIDUAL) NAME (print) Dom 5 h t ln� � I Sfln CERTIFICATION N Xe-f
11 N
WELL CONTRACTOR COMPANY NAME �:IIP( 1n1 G.II (V f,I��/i�� PHONE (52t) `S7`26't
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential l-Municipal/Public 0 Industrial 0 Agricultural ❑
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:nlu('Dkay County( (74A6'.
ton\\Ori t.
(Street Name, Numbirs, Community, Subdivision, Lot No., Zip Code)
41
3. OWNER: 5,c,-Pc't f C1I) Di ML\Pt>
Address W - Oi QR .331a 1 Of •
m (Strees t-or \Route No.)
1 11US6L� tiles—
Zip Code
City or Town State
Area code- Phone number
4 DATE DRILLED -7-
5. TOTAL DEPTH: (1/Cc'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118. n
9. YIELD (gpm): '( METHOD OF TESTA' F
10. WATER ZONES (depth):
276616
Topographic/Land setting
Loge ❑Slope ❑Valley ❑Flat
aooroptiate t cJ)
Latitude/longitude of boll ?^notion
/V- ?5;1O,3 ;59, tJ-$i'o' :5
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forma9on Description
DEPTH
Frpm To
(J 1 c5
S - .. P / 'S / . E G-/E
30-1y(-
II. DISINFECTION: Type\"+ ye\k)-k Amount
12. CASING: Wall Thickness
Diameter or Weight/Ft. Material
( /O/ Ft.6,-2S 5oR1 �)v(
From
From
From
13. GROUT:
From �>
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth
To
To
Depth
To
To Ft.
To FL
Depth Mae al Method
To Q0 Ft. n -.) .4 DCCS&tI�
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
From Ft.
From Ft.
Size Material
LOCATION SKETCH o
Show direction and distance in miles Nam atjeast
two State Roads or County Roads. Incle the road
numbers and common road names. eftt
74
,soy
/17usSc/
0
rn
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL. WAS CONSTRUCTED IN treGILDANCEWITH4-5A-NCAC R , WELL
CONSTRUnTION STANDARDS, AND THAT A COPY OF THIS RECO iipMS BEEN PROVIDED TO THE WELL OWNER
Iy_
_- 2' ftit _-
n
SIGNATURE OF PERSON CONS'iFLU i . ru5 WELL
>
Submit the original to the Division of Water Quality, Groundwater Seetktn,1636Mtli1 S.ertC.euteti - Ralcit . NC
27699-1636 Phone No. [phone], within 30 days.
GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
276615
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print):\aryl AS R. LC) i150r\
CERTIFICATION # au 04
WELL CONTRACTOR COMPANY NAME JY):Uo r t;)Pi\ rk.\``,nn PHONE # j)1.2`i q57-.295t
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential D- llunicipal/Public ❑ Industrial ❑ Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: (Y)tAfpH�
ynnrrp(.\ r1
County Ono m)(P e_
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: ) P-Cc 14m, ^c, t—€S
Address 140%7) e-yC tay_
r� ' ` (Street or Route No.) rLrba outr(iuz Q Town State Zip Code
City or
( )-
Area code- Phone number
4. DATE. DRILLED 7 — / 7- T1;
5. TOTAL DEPTHS 3QS 1
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO ❑-
7. STATIC WATER LEVEL Below Top of Casing: SO F T
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS ! FT. Above Land Surface"
*Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): METHOD OF TEST 4 t R
10. WATER ZONES (depth):
11. DISINFECTION: Type h}1,t pp\\p\-S Amount '2F)
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Frorrt__o__To 101' Ft. (0..2A-' SQ? l Q ✓e
From To Ft.
From To Ft.
13. GROUT: Depth Material) Method
From D—_To 02o' Ft. P car`` c;r- c/ pressure
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ftin. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUU l ED IN Vi
CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS RECOIL; L.
Topographic/Land setting
[Midge @Slope ❑Vahey ❑Flat
(check appropriate box)
Latitude/longitude of well location
5f//;/ /42 ,eq /3;7Q
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEEM DRILLING LOG
From To Formation Description
V — f0`
pt J G�
�` /i/r
LOCATION SKETCH w
Show direction and distance in milesm at least
two State Roads or County Roads. In6fade the road
numbers and common road names. —
9- ,r, t-- lii()A-P/Jo�- I
SIGNATURE OF PERSON CONSTRUCTING THE, WELL --I DAE
Submit the original to the Division of Water Quality, Groundwatet-Sr on,163b MaI rvice Centt(h- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001
rs
WELL
S BEEN PROVIDED TO THE RDANCE WITH 15A NCAC 2
WELL OWNER
7 7'7 /5 1'

WELL CONSTRUCTION RECORD
Noah Carolina - Department of Environtnent and Natural Resources -
WEI.LCONTRACTOR (INUIVIDUAL)NAME (print) SHANE WALKER
WELL CONTRACTOR COMPANY NAME YADKIN WELL CO., INC
276491
Division of Water Quality - Groundwater Section
CERTIFICATION', 2415
PHONE q f 336) 468-4440
STATE WELL, CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT',
(if applicable)
(if applicable)
1. WELL USE (Cheek Applicable Box): Residential I Municipal/Public O Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL. LOCATION:
Nearest Town: MURPHY
TARHEEL PROPERTIES
County CHEROKEE
(Street Name, Numbers, Community. Subdivision, Lot No., Tip Cole)
3. OWNER: ERIC MASHBURN
Address P.O. BOX 1044
(Street or Route No.)
MURPHY NC
28906
City or Town Stole Zip Cale
( 828 )_ 837-1917
Area code- Phone nnmher
4. DATE DRILLED 07-23-2003
5. TOTAL, DEPTH: 420'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO El
7. STATIC WATER LEVEL Below Top ofCasing: 80 FT
(rise "+" if Above Top of Casing)
S. TOP OF CASING IS 1' FT. Above Land Surface*
`Top of rnsing Ierminnled et/it below land surface require a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpnt): 3 METHOD OF TEST AIR
10. WATER ZONES (depth): 238'-239' _
Topographic./Land setting
DRidge FBSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
Idcgreedminutes/seconds)
Latiturlcilongitudc sourcc:OGPS❑Topographic map
(check box)
_UPPTII DRILLING LO(i
From To Formation Description
0' TO 40' SOIL
40' TO 50' SLATE
50' TO 107' MED BLUE GRANITE
107' TO 108' SOFT SPOT GRAY
194' TO 195' SOFT GRAY
238' TO 239' FELL
MED GRAY
239' TO 420'
AAH - 772
BIT S/Nf 30098-24 BIT SIZE 6.078 r"s
LOCATION SKETCH CO
I I IDI SIN ERC ('ION: Type CHLORINE Amount 100 PPM Show direction and distance in miles from feast r-�7 -.
12 ('ASIM(': Wall Thickness Iwo State Roads or County Roads. Include thR road-`
Depll, Diameter or WeighVFt. Material numbers and common road names.
From + 1' _ To 79 FL 6 1/8' SDR 21 PVC
From To 171.-_.--
Fria nTo.-_-- Ft.
13. GROUT: Depth Material Method
From O. "To 20' Pt, CEMENT GRAVITY
FromToFt._
14. SCREEN: Depth Diameter Slot Size Material
From 'To Et. in. in. __._..—.
Prom__ To Ft. in. in.
15. SANI)/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Pl.
16. REMARKS:
I DO IIIIRETh CER 1I IAI IA'I
CONS ('ONS[RUC'l I ON STAN DAR
IS WELL WAS CONSTR
ND '[RAT Qrc,OPy Qt
tCl ED IN ACCORDANCE WIT' 115A NCAC 2C, WELL
US RECORD HAS BEEN PROVII)ED'TO THE WELL OWNER
2._
SIGNATURE OF PERSON CONSTRUCTING THE WELL
T--23-02.
Submit the original to the Division of Water Quality, Groundwater Section. 1fi36 Mall Service Center Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/2001

276409
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso es -Divisii�ogn of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) rR8AI Z • V tc tut R CERTIFICCA�TION # 3/ 75
WELL CONTRACTOR COMPANY NAME .8 vGRS Welk-I)nt(-L') hiC1 PHONE tinyWm 7 Z/
STATE WELL CONSTRUCTION PERMITS/ ASSOCIATED WQ PERMIT#
ifa'cable if 'j.licable
1. WELL USE (Check Applicable Box): Residential Cl Municipal/Public 13"----industrial 0 Agricultural 0
Monitoring 0 Recovery Q Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: (YHA Pik/ County CACAO KGC-
WItDC2rtC.5s C2K. Falls c.z7o/}cci gD
(Street Name, Numbers, Community, Subdivision, Lot No., Tao Code)
3.OWNER:7LE14 t1Z 1(^
Address 7Cs Act-6..
coPXg,4-iLt on N 3 / 7/3
.ty or Town State7ti�� -7/y
Area code- Phone number
4. DATE DRILLED ✓0 - 23
0
3
5. TOTAL DEPTH: LI 7 Ci
6. DOES WELL REPLACE EXISTING WELL? VES O NO e
7. STATIC WATER LEVEL Below Top ofCasing' FT.
(Use "a" IT Above Top of Casing)
8. TOP OF CASING IS r'C FT Above Land Surface"
'Top of cuing terminated at/ur below land endue requires a
variance In accordaaco wish 1SA NCAC 2C .0118.
9. YIELD (gpm): 4 7 TROD OF TEST Mg
10. WATER ZONES (depth): '/ 7
Zip Code
11. DISINFECTION: Type i71 771 Amount / /D
12. CASING: Wall Thickness
Depth Diameter or We t/Ft. Material
From 5-0 To -i- ? Ft. c,'VW . 1 �- -S%(e/
From_ To_ Ft.�_
From Tol, Ft,
13. GROUT: Depth _ Material Method
From_L To .'5 C.)Ft. C6MeArr ,�9UM/0
From To Ft.
14. SCREEN; Depth Diameter Slot Size . Material
From To Ft.___ in. in.
From To Ft, jn in
15. SAND/GRAVEL PACK:
Depth- Size Material
From To Ft.
From _To Ft.
16. REMARKS: (v 74
Topographic setting
QRidge DSlope alley ❑Flat
(cheek appropriate box)
Latitude/lassittideof well location c
C7z . /)iCG' I $ 77Z
(de eeerninutes/secoods)
Latitude/longitude sour-ce:DGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
ORarvv.C- CL2✓
7ij C-Lr7v
cangezco /erk
Cf,
DEPTH
From To
0
2 '
7ro
r43 3/7
3 /7 y%S
L cR& 2oCl:
/1',-NerG'Z 71,0R /2 722 G
LOCATION SKET_CFi
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
1 i CONSTRU N STANDARDS TH T A PY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
q
(/ 6 -23--0
SIGNATURE. OF PERSON CONSTRUCTING THE WELL DRIB
Submit the original to the Division of Water Quality, Groundwater Section., 1636 Mail Service Center - Raleigh, NC
27699-1636 Pbone No. [phone], within 30 days, GW-1 REV. 07/2001

WELL CONSTRUCTJON RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME(print) FP c'1 hl a.P. V/ 00R CERTIFICATION *3 (7-5-
WELLCONTRACIOR COMPANY NAME R4' 1712(C6//`Ie PHONE it 7q5-2/e6
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
ifalicable . , if -� .1icabie
1. WELL USE (Check Applicable Box): Residential 0 Municipal/Public b' Industrial 0 Agricultural ❑
Monitoring 0 Recovery O Heat Pump Water Injection ❑ Other 0 If Other, List Use
276408
2. WELL LOCATION: J Topog apklic/Lan g
Nearest Town: NOR r(t r couQyCnti2Ot«=t 0Ridge ❑Slope I9Valley OF1at
& OdObleSS cj2J ,1=2LLS 270 /4UCM,2r0 .3i'713 r (check appropriate eta)
(6croet Name, Numbers, Community, Subdlvisicn, Lot No., 7..ir Codt) Latitu4,flongirado of Well loratiou
3. OWNER; G.LC- PReNK
Address n270 14-14-C—z 11 L
(Street or Route No.)
e®at Q 1kL ' TL--64-N. a(7/3
N/4- �«4(r /7;4 Zip Code
Ara code. Phone number //� -I
4. DATE DRILLED fr$ 0-0 3
S. TOTAL DEPTH; S
6. DOES WELL REPLACE EXISTING WELT 7 YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing; gm- 2.— FT
(Vre
8. TOP OF CASING IS �. FT*Above Land Surface`
'Top of cuing terminated at/ue below land sutras requires a
variance In accord o with 15A NCAC 2C .0118,
9. YIELD (gpm); METHODSF TEST ill R
10, WATER ZONES (depth): /-SJ
11. DISINFECTION: Type ifTh4Amount -lift I b
12. CASING: •
Wall Thickness
From42-
DeTopthSO Ft Metter
, or UFL 5YMaterial
/ f L
From_, To Ft.
From ToPt.
13. GROUT: Dept Material Method
From Q To. i7 .Ft. CC- t „ 9024-ri0
From To Ft.
tki 35°02 OSFi'G/ogle it 772
(degrea/minutesheeoads)
Latitude/longitude sotirce:OOPSOTopographicmap
(check boz)
DIILLING LQG
Formation Description
— Teti Ct9M
✓� (.�Ca ill/O, rime,
/7
Vi RO ficlt
Dr?/k cc/2?g✓M .e'Thar
L.T, G17-i' r'2o c-*
fk?A trc &a_; 4fD2 cat-h,
DEPTH
From TQ
is '>
t.['ki
14. SCREEN; Depth Diameter Slot Size Matetial
From, To Ft in. in.
From To Ft.�an. in.
15. SAND/GRAVEL PACK:
Depth:
From To
From To Ft,
l6. REMARKS: WEW
2t2
Size Material
Ft.
LOCATION SKETCH
Snow direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and cotlunon road names.
0
L.)
V
71.
O
r
cn
n a
0
1 DO-14ERBBY-CEEnRY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH ISA NCAC 2C, WELL
CONSTRUCTION ST ARDS, AND T�IAT A COPY OF TH]S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OP PERSO CONSTRUCTJNO THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 clays, GW-i REV. 07/2001

276380
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
q
WELL CONTRACTOR (INDIVIDUAL) NAME (print) W��-kACV .S. (� � CERTIFICATION #(T/
WELL CONTRACTOR COMPANY NAME W M (L� ' 1t2 &(-L1t "4 PHONE # frae6SVI
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
ASSOCIATED WQ PERMIT#
(if applicable)
I. WELL USE (Check Applicable Box): Residential /Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
City dr T
('1 - (o�k� 1-ro
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: tat-
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: \aD FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS t FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accord q ith 15A NCAC 2C .0118. n ` w
9. YIELD (gpm): I1k- MFTHO� OF TEST 0-1-+i
10. WATER ZONES (depth): ! ��
2. WELL LOCA //���� i
t ToV`XW�� CountyL�t�
(Street Name, Numbers, Oommunity, Subdivision, Lot No., Zip Code)
3. OWNER:
Address 2/t43 VIAllithiPt4v
(Street or Wo..2 Ds„
Oc7
Zip Code
11. DISINFECTION: Type F4iF4- Amount
12. CASING: Wall Thickness
Depth Di r or Weight/Ft. (—Material
From C) To `tt.) Ft. (dAi S�Qfg"?.(o x-'vC
From To Ft.
From To Ft.
13. GROUT Dept Ma rjal(A
From To Ft. ff
From To Ft. t
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
opographic/Land setting
dge 0Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/secoods)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH DRILLING LOG
From To i FormaDescription
p is
I' c'
,b t i 1'%I9'
CO
r—
r—
IV
LOCATION SKETCH ry --
Show direction and distance in miles from arjte,ast
two State Roads or County Roads. Include tgroad=
numbers and common road names.
('DOIHEREBY :tERTIFY5
IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
THAT A COPY OF IS RECORD HAS BEEN PROVIDED TO THE WE 0
ON CONSTRUCTING THE WELL DA
Subndt the-M• ggtaTFp k!ie Divi ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
2709-1636 Phone No.19119 733-3 21, within 30 days. GW-1 REV. 07/2001

276265
WELL CONSTRUCTION ItECORll
North C:nolina - I)ep; tumid of Environment Land/Natural ResouFccs -Division ofAValer Quality - Groundwater Section �/�
ta 1. CON I RAC I0121INIII\'II) I IAI.)NAMI( (print) 1 Ah y Col//LA/3� _. _ CFAFIF ICA I ION d �41"'��
\\ELCt)NI It N,\N1b: �„%"t'�-N-QL�e- �1fS�.L/ +�Qt �ll�- PfloN)] a(5,713-1008
ASSOCIA I El) \\'Q 1'I 11,M11 d
(if applicable)
SI.AIl: AvI:I.I.(:O SI n11(1IION PI:enlITN
(11;1 plicutile)
I. AA'liLl. USE (Check Applicable Box): Residential Ely---Municipal/Public ❑ Industrial ❑ Aericullural ❑
Nloniloring ❑ Recover}' ❑ I Zeal Pump Water Injection ❑ 011icr ❑ If other, I-isl Use
2 WEI.I. LOCATION: //�'/ /��_�_�,., �1�,q--�
Nearest -Lowly rnu�� County `�11812,A.
Lot let'L— k)C i 2thci-C DILVC
(Snccl Nuuc, Numbers, Community. Subdivision, Lot No_ Zip Code)
3. OWNE.It:_biLLLLV
(Slrucl or Route Ni.) '75S c
A ti ftl y C- 1 lh
City or 1, un Smlc // 7ip Code
($ )- a137- G a6 _�
Neu cdc- Phone number
4_ DATE l)RI1,LIIDA-y-o3
5. -I OTAL. DEI'l 11: in 0.5
6. DOES WELL REPLACE EXISTING IlNG WELL;? YES ❑_Ng. Cc✓
7. STATICWAII?RLEVEL BelowTop ofCasing: 25 11
(Use „-C. if Above lop of Casing)
R. 'I -OP 01: CASING IS L 1: 1'. Above Land Sul face'
•l up nil c:aing Iv'ImInalcd al/or beIo.s I:Ind surface rupdres a
c:ni:u¢e Its afro' chute a1tll 1 i\ NCAC 2C .11118.
(I YIELD(gpm): 6 MEri1ODOF11ST/i7R [j_fT
10- WATER ZONES (depth): L.70_, yyo
11. DISINFECT ION: Type C LOR/Nk Amount -3 C(,as
12. CASING: Wall Thickness
Depth Di;unctcr or \\'cighL'Ft. Nlalcl ial
f rotn O T(' 67.rl. 6----Y SoR ,?t _I'vC-
1:1( 1 To I'I.
13. (;ROU11 Depth Nl:rc'i;d
I font 0 To .Zo :1. Co/Yck67e.—
in To PI.
I\ It:fluid
GRAtLry
1,1 SC'IREIFN: Depth Muncie' Slot Sizc Nlalcli;d
ton) To 3. in. in.
loos-"- lo _—_Il._ _ in in
15 SAND/(i12AVI=.I.PACK:
Depth Size Nlalci ial
Ynm 1 U 1-1.
10111 To I'l.
I6. IftNIARKS:
From
0
f5
�o
Topographic/Land setting
2idge ❑Slope ❑Valle}' ❑Plat
lchcck nrrrn1•rinte ho.I
Latitude/longitude of well loctdion
Ideptecs: mina lccisccnmds)
(check hurl
DPI' I I I DRILLING LOG
To Ruination Description
6S $� - SAmag . C,t y
' o LPubir//bpis, saMosto,v,
6o3 /31-ue S4ire
0 _.
rn
1 OCIAI ION SKI':I ('I I
Show direclion and distance in miles lion al lend
Iw'u Stale Roads or County Roads. Include the road
nun)bcls and common road names.
0
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W
U
ID() I II RI'13Y PI It IIFS'
CONSTRUCTION STANLJ
1jv1 I111S WELL WAS CONSTIUJ(-LED IN ACCORDANCE WIIII I5A NCAC 2C, WI.I.I,
DS. AND I11AT A COPY OP IIIIS RECORD IIAS BEEN PROVIDED"! 0Il1E WELL OWNER
-2-y-03
,NA I URE OF PERSON CONS IRIJCI INC, 111E WELL DA I E
>
Iunl
Submit the ol_nr �) the �)ivWall of \Paler Quality, Gruuud\c;tter Section, 1636 Mail Service Center - Raleigh, NC
.
2iY,yq IGIG Phone idF), J71')) jii-1221, wilbin III (la) s. (iW-I ItEV07/2001

WELL CONSTRUCTION RECORD
279521
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (prino LARRY F. JONES
CERTIFICATION II 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. pnONE / [phone]
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WI) PERMITS
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El Municipal/Public 0 industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Usc
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
VALLEY RIVER MTN. - DAYLILY DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LEWIN WEST
Address 963 UPPER PEACHTREE RD
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Code
( 828 )_ 837-7820
Area code- Phone number
4. DATE DRILLED 08-14-2003
Topographic/Land setting
®Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(cheek hex)
DEPTH DRILLING LOG
Frotn To Formation Description
0' TO 40' RED CLAY
40' TO 74' SAND & GRANITE
74' TO 305' GRANITE
5. TOTAL DEPTH: 305'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 225 FT.
(Use "+" if Above 7op 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 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST AIR
10. WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from a
two State Roads or County Roads. Include limo
numbers and common road names. ••
Z
I I. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 74
From To
Amount 100 PPM
Walt Thickness
Diameter or Weight/Ft. Material
Ft. 6 1/8" SDR 21 PVC
Ft.
From To Ft.
13 GROUT: Depth Material
Froin 0 To 20 Ft. CEMENT
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Si7
From To Ft.
Frorn To Ft.
16. REMARKS:
Method
GRAVITY
Slot Size Material
in.
in.
Material
_h
�.J
I DO IIEREBY CERTIFY TUAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIIII I5A NCAC 2C, WELL
CONSTRUCTION STANDARDS, AND THAA A COPY OF THIS RE OI2D HAS BEEN PROVIDED TO THE WELL OWNER
IRUCIING TUF. WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail SenIce Censer- Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-I REV. 07/200
C-3
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WELL CONSTRUCTION RECORD 27925
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) LARRY F. JONES CERTIFICATION 8 3295
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERM1T#
ASSOCIATED WQ PERMIT#
(if applicable)
(if applicable)
1. WELL USE (Check Applicable Box): Residential ® Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery 0 Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MURPHY
VALLEY RIVER MTN. - DAYLILY DR
(Street Name, Numbers, Community, Subdivision, Lot No., tip Code)
3. OWNER: LEWIN WEST
Address 963 UPPER PEACHTREE RD
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Code
( 828 )- 837-7820
Area code- Phone number
4. DATE DRILLED 08-20-2003
5. TOTAL DEPTH: 807'
6. DOES WELL REPLACE EXISTING WELL? YES O NO El
7. STATIC WATER LEVEL Below Top of Casing: 43 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below hand surface requires a
variance in accordance with 15A NCAC 2C .0118.
9. YIELD (gpm): 1/2 METHOD OF TEST AIR
10. WATER ZONES (depth):
County CHEROKEE
Topographic/Land setting
KlRidge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DEPTH DRILLING LOG
From To Formation Description
0' TO 20' RED CLAY
20' TO 34' RED CLAY & SLATE
34' TO 807' SLATE
11. DISINFECTION: Type CHLORINE
12. CASING:
Depth
From 0 To 34
From To
From To Ft.
13. GROUT: Depth
From 0 To 20
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size
From To Ft.
From To Ft.
Amount 100 PPM
Wall Thickness
Diameter or Weight/Ft. Material
Ft. 6 1/8" SDR 21 PVC
Ft.
16. REMARKS:
Material
Ft. CEMENT
Material
-c
Ca)
CC:672a
C:
Yrn
PO
VC
>c
LOCATION SKETCH = c
Show direction and distance in miles from a ast c' 2-'
two State Roads or County Roads. Include CO
roa
numbers and common road names. CO
I. ----
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELLr
CONSTRUCTION STANDARDS, AND THAT A C Y OF THIS RECORD S BEEN PROVIDED TO THE WELL 0 ER
SIGNATU OF PE ON CO STR G THE WELL DATE ! = . i
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh] NC -
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 09/200 )

27925
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) TARRY F. JONES CERTIFICATION # 3295
837-8008
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY, INC. PHONE k J828)
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMED
(if applicable) (if applicable)
WELL USE (Check Applicable Box): Residential El Municipal/Public 0 Industrial ❑ Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
1
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE
VALLEY RIVER MTN. - DAYLILY DR
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: LEWIN WEST
Address 963 UPPER PEACHTREE RD
(Street or Route No.)
MURPHY, NC 28906
City or Town State Zip Code
( 828 )- 837-7820
Area code- Phone number
4. DATE DRILLED 08-15-2003
5. TOTAL DEPTH: 305'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO El
7. STATIC WATER LEVEL Below Top of Casing: 252 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 2C .0118.
9. YIELD (gpm): 0 METHOD OF TEST AIR
10. WATER ZONES (depth):
Topographic/Land setting
®Ridge ❑Slope OValley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:OGPSOTopographic map
(check box)
DRILLING LOG
Formation Description
RED CLAY
20' TO 58' SANDSTONE & GRANITE
GRANITE
DEPTH
From To
0' TO 20'
58' TO 305'
11. DISINFECTION: Type CHLORINE
Amount 100 PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
From 0 To 58 Ft. 6 1/8" SDR 21 PVC
Ft.
Ft.
13. GROUT: Material Method
From 0 Ft. CEMENT GRAVITY
Ft.
Diameter Slot Size Material
Ft. in. in.
Ft. in. in.
From To
From To
Depth
To 20
From To
14. SCREEN: Depth
From To
From To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS W
CONSTRUCTION STANDARDS, AN
NATU
LOCATION SKETCH
Show direction and distance in miles from a
two State Roads or County Roads. Include Ifiee roa N
numbers and common road names. IV
re-o
k IA D -L(( L
X
N
tJ
o
AS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECOOBtttS BEEN PROVIDED TO THE WELL OWNf,..
OF PERSON'CONS
i•>2 2
ING THE WELL
DATE
Submit the original to the Division oft a ter Quality, Groundwater Section, 1636 Mail Service Center- REVgbj 2QQ
27699-1636 Phone No. [phone], within 30 days. G
-rt
rri
CC
na
cn

WELL CONSTRUCTION RECOR1/
North Carolina - Department of Environment and Natural Resources - Division of Water Quality
\ctl.l. At (INDIVIDUAL) NAME �(y�•Im) 714NDY ���,Co/�iNSI 1
\\ ELL CON III \ CI Ott COMPANY NAME _c_ 1��J Lc-�c:I I l2ktJIJ—Nci
si Al I'. AA ELI. CMS I Itt C I IUN PERM! It! _ ASSOCIAI El) Avf) 1'r; 0111 N
lit applicable) (if applicable)
- Groundwater Section
CER IIEICA'FION NAM'
PHONE N
1. AVNI.I. USE ((Beck Applicable Box): Residential lg-7--Municipal/public 0 Indust' iul ❑ Agricultural 0
Monitoring 0 Recovery ❑ !Ica( Pump Water Injcclio❑ ❑ Olhcr ❑ If Other, List Use
2 VCEI-I.I-OCATION:
Nearest Town: 4^IIbJ2 5 County Cite-Fyke
I312.1b1' iii LJI
(Slicer Name. Numbers. Conummi;y, Subdivision, Lot No Zip Code)
3 OWNER: 3,-?7 Hu6H6S
Address PC
'sot,' of [took No.)
�4JL)F LJ
Ciry or I imp Stab
-33Co1
Area code- Pl anc Humber
4. DATE DRILLED .2-7-o3
5. 1-OTAI. DEPTH: 2 2 S
6. DOES IEEE REPLACE. EXISTING WELL? YES 0 NO
7. S VATIC WATER LEVEL 13elow Top of Casing: /O IT.
(Use "+" if Above Top of Casing)
8. TOP OE CASING IS 1 FT. Above Land Surface*
`l op of rasing terminated al/or Lclo%v laud sae face requires a
lad:ince in accordance nllh ISA NCAC 2C .(1118. ) /t /� /,CL
9. YI1LD (gpm): _5 0 METHOD OF TEST Ii
ID. WATER ZONES (depu)): 12o / /9S
II. DISINI'EcrioN: ypeCNLD/Q/NL• Amount .2 Cops
12. CASING; Wall thickness
Depth Dial)mlcr or Wciglt/fl. Material
%`°/
Zip Code
Topographic/Land selling
❑Ridge ❑Slope NSIalley ❑flat
lclwck appropriate box)
Latitude/longitude of well location
(tcgrccslntintev (muds l
Latitude/longitude source:❑(,I'SO topographic map
(check bax)
DRILLING LOG
Formation Dcscripl ion
n /p RAD S'IN.OY CLAY
7qN —5aNZIY CL'4Y
C,JFATNERE$ .3gow4/ S L474
SLVS SLx1rs
DCI'II I
From To
/0 ys
45 80
BO I/O
//o -2,25
I3
rout O Ta // D ft. (o -Y
1
hour To Fl
1:rout To fl.
GROUI` Dcpllii Material
:IOIII 0 I o #20 Ft. t' /?- � %
hull_ ;_ To / /U _ H.Ccttni15"
SCREEN: Depth !thunder ✓Sloe Size. v
from _ .lo Et. in. in.
From -Fri Elin. in.
15. SAND/GRAVEL PACK:
Depth Size. Nlalcrial
S» . i PvC
Etoln to II.
16. REMARKS'.
13Lv6 S4.177
LOCATION SKEICII
Show tlirec(ion and disi:ince in miles from at (cast
two Stale Roads or County Roads- Include the road
numbers and common road names.
O
W
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co
(D
W
c
6
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JN§tRL1011()N Si A DA
--7
IIS \VELI. WAS CONS LRUC1 EI) IN ACCORDANCE WI III15A NCAC 2C, WL(
NU Il IA I' A1 OF 1115 RECORD IIAS I3EEN PROVIDED] 0 111E WELL OWNER
y;± r ,NATURE Of PERSON CONS I RUC I ING 1Ill? WELL UATG
Subunit Ihe nu irginal lu Ili UiviFion of Wader Quality, Groundwater Section, 1636 Nlail Sri ice Center - Raleigh, NC
ThWVF1636 1' hone. No:1m9) 733-:
ASHEV'ILLE RES C",.'. C:WCE
2-7-0_5
221, within 30 ;lays. G\V-I REV. 07/2001

268581
cmisTRuctitl S
MAR _..�
Submit the or to the I
27699 1636I honLN1 ' 19) 7
6f �,Ulr SECTION
ASHEVILLE REOIE'r;tit OFFICE
«WELL CONSTRUCTION IZECORU
Nei lb (arolino - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\rll.l. CON -I It:\CIOlt (INDIVIDUAL) NAME (print) X' /4( w CV //r S CEIt1IEIC\710N
W El 1. C(!YI ItAClOIt COMPANY NANII geree. P4P1 I'IIONE 0 f )
Sl,\ I \\ 111.L (O\Sl Itl'CIION I'I ltMI'l# ASSOCIAIRP \\'(211EltdlI11
Ill applicable) (if applicable)
I. A1'EI-I, USE[ (Check Applicable 13ox): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ I leaf Pump Water Injection ❑ Other 0 II (illier, List Use
2 AVELI. LOCATION:
Nearsrt Iovui: 1-64RPti�
Luis ;L/ 2J.
19rca1 Name. Numbers. Community, Subdivision. Lot No_ Zip Code)
County,
3. OWNER: Q1%Un.--OD430).5
Address 9.23—
(Sheet or Ironic Ni.)
Hid? /)f4y 1oc
(_ I i Toro � Stale
-i -,Zip Cnde
I f_ 9 SV- f 33
Nca code- Phone number
/I DATE DRILLED.-6 `OS
5- TOTAL DEPl11: ,22 J
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO EV
7. STA f IC WAIER. LEVEL. Below Top of Casing: 57-, fl .
(tile "✓' if Ahnvc Tip of Casing)
8. TOI' OF CASING IS I I'I'. Above Land Surface'
'Toy it rising ter minalcd al/or hello% laud surface requires a
%aflame in accordance eiIl, ISA NCAC 2C MIN.
9. YIELD Igpm): ME IOD OF TES 1' 74 14 PT
Topographic/Lan( setting
Oltidge ❑Slope ';prey ❑Ilal
(check appropriate box)
Latitude/longitude of well location
(dcgrccs'minacs/sccondsl
Latitude/longitude source:❑GI'S❑Topographic map
(check boa
DIM I.LING LOG
For motion Description
DL,I'l' i
f0rll Sr £nPP- /ZL-a CAA/
_5 J 5H H___S-4-2.
3/ .225
10. WA LER ZONES (depth): /90
II. DISINPP.CFION:'IypeCHrOR/.. Anounl.2 Cups
12. CASING: Walllllickncss
Dtplh Diameter or Wcighi/PI. Malcrial
1.10111 0 'Io 3 / ft. 5P—LaZi j3✓L
1:10111
Ion) T 0 It.
(11 0UI Depth Nlalerial Nlclhod
II Om 0 To ,20 II.
13
15
From To lit. ----
SCREEN: Depth Diameter Slut Size Material
Ilom To 1.1. ill. in.
From Io --� II. in. in
SAND/GRAVEL PACK:
Depth Sizc Nlalcrial
Dow TO lit.
from To Ii1.
16. I<IiMARKS:
N_L7-4
4_4W7
CAC%f S/gr_C
•
LOCA'I ION SKIiICII
Shots dircction and distance in miles from al least
t\vo Stale Roads or County (toads. Include the road
numbers and common road names.
O
CO
171
CO
CO
C.J
I DO I ILREID1' ('ER I IIAT ll IIS WELL WAS CONSTRUCTED IN ACCORDANCE WI I11 I5A NCAC 2C. WE.LI.
S. ANb 11I l'Y OI' 111IS RECORD IIAS BEEN PROVIDED 1(31I IE. AYELL OWNER
SIGMA T(1 RP OP PERSON CONS IIt(1C IING 11 Ili \YELL DA l ti
vision of 3Valcr ()wilily, Groulld\saler Section, 1636 Mail Service Ccnlcr - Raleigh, NC
3-3221, \vi(hin 31) days. (iW-1 REV. 07/2001

268582
WELL CONSTRUCTION RGCORZI)
North Cmolina - Department of Environment and >l.Natural/�Resources - Division of Water Quality - Groundwater Seelion
wIAA. CON I IIACI OR (INDIVIDUAL) NAME (pr II) aiAjo Y Co//1ns CERT IFICA TION II .29.3v
„F.1.1. COS 1 ItAC b it COIMI•ANY NAME F Dke-l%d /�th11h 7 I'IIONE k 0,r3)8-c-7'$Qt7S
S I Al I. w i:t.l. CONS'I ltUC1 ION I'ERM1171 ASSOCIA IEII A,'Q 11EILMITH
(II :Ipplicable) (ill applicable)
1 WELL USE (Check Applicable I3ox): Residential frtl unicip; l/Public 0 Industrial 0 Agricultural 0
Muuiloring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ I l Other, List Use
2. WELL LOCATION:
Nearest Town: /Mif County( /LCP0�C�_
MC -IN Pe L-- EST
ISlicel Name. Nuu1hcIs. Conmumil`y\Subdivision. Lot No., Zip Code)
r.
3. OWNER: Cti�J> �
Address 3-3o VAl_NVL
(Street or Rouu )7 73 6
��y� G :253
City or Friuli Slate Zip Code
(fztS.)- C6, 7 - Flo I 0
Area coda Phone number
4. I)ATT DRILLED ,2-3 - 0-3
Topo�gl�ayhic/Land selling
❑Ridge MS lope ❑Valley Opal
(check nppropl iate box)
Latitude/longitude of well location
I do grccs/min roes/scconda)
Latitude/longitude source:O(il'SOTopographic mall
(check boxl
DEI'111 DRILLINGLOG
Horn T Formation Description
.2S So
5. TOTAL DEPTH: 2(9 5 60 6 /
6. DOES WELL RI;I'LACE. EXISTING WELL? YES 0 NO Er so ci
7. STATIC WATER LEVEL Below Top o1Casing: So ET. , 9,5 2o3
(Use"+•' if Above Top of Casing)
8. TOI' OF CASING IS I FT. Above Land Surface*
• Top of rasing ttrminaled at/or below land surface requires a
variance ill accordance will, 15,\ NCAC 2C .0118.
9. YIELD (gpm): I_5_ METTI012 OF TEST4lie Lip-7
ID. WATER ZONES (depth): ' Si To
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth r Diameter or Weight/Ft. Material
From d •i tt Ft. 6 iy
Flom To I'1,
From Fe Pt.
13. G120U1: Depth Material Method
Twin D To 5o Ft. Ce,r,P✓r jp_av Tl/
nom TO :1 J
Id_ SCRIiIiN: Depth Diameter Slop Size Material
Ilom fo 1'I. in. in.
Flom to PI, in. in.
15. SAND/GRAVIl1. PACK:
Depth Size
I Tom Tn I-1.
TO FI.
sa,Pzi F✓C
from
Material
I(,. REMARKS:
LLD SI74,,7Y ClfgY
G✓Gr,ithG-D MANtE
ep/pg
SofT to cif
e u&-
LOCATION SKGFCII
Show dilcclion ail distance in miles from al (cast
two Stale Roads or County Roads. Include the road
nunhbeis and common road names.
0
-rl
0
CO
w
I 130 III-RE1)Y CFRllll' IA I11IIS WI61,I, WAS CONS IRUCI ED IN ACCORDANCE WI III I5A NCAC 2C, AVELI,
:CC lit.S1IfitlC 1l10.6SI I )5.AND11IA ACOI'1'OF ITIISRECORD IIASELI NI'12OVIDI1)]OMIT:1VELLOWNER
� I�s 1 �I '.� S
rl 1 // /7 .2-5 - a 3
iICNA'fllltIiOhI'LRSON CONS IRtJCI INC'I IIL AVlU.I, DATE•
ct:
Sulrnul the m i;;in;ll lu Ie ivision of 1\'afer Quality, Groundwater Section, 1636 Mail Scr vice Center - Raleigh, NC
L 27699-1636 Plume Ni. (9 9) 732-3221, within 30 days GW-1 REV. 1)7/2001
ASNEViLLE FliCHCE

26858,E
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and /N�attlural Resources /- Division of Water Quality - Groundwater Section
o r:I.L CON I il:\('7 Olt (INDIVIDUAL) NAPIE (prin//t)� "r 'amp y C' 01 /1AiS CLIE1IFICATION IX 24' p
1(I.1. CON 1 ItAC1 ()It CI).\ll'ANP NAPIE. _lLe.o _ee. L4.) // Pei 11/.:!3j I'IlONE a (87d)8'Z-�r'O
SI.\'11: \\ I:I.1, CONS'I Itl'.0 I ION PE1I8II11/ ASSOCIA I En U'Q I'leltMI TIX
DI applicable) ( if applicable)
VVIiI-I: USE (Check Applicable 11ox): Itesidenlial EKfvluuicipid/public ❑ Industrial ❑ Agricuhural ❑
Monitoring ❑ Recovery ❑ Ilea( Pump Water Injection ❑ Other O If Other, List Use
2 VVI?LI, LOCATION: JJ�
Nearest 'I own: mu Counly_C/
TicP_ti(eeL— R -E .13 ve
ISbect Name. Numbers. Community. Subdivision. Lot No.. lip Code)
3. OWNER: //Q N &i3t5 - LL
Addles 3 2J 1.JG'sT RIb&1= Dom) 1 VC
Litt L
,(Str�eet or Nrrt is Nor� �
11�
(ily on Iron Stale Zip Code
(Sf_)- $ 3?- G?Ca710
Anew cute- I'brne nunghcr
d. DAT li DRILLFl)2- y-o3
5. TOTAL DEI'lll: 605
6. DOHS \VIiLL REPLACE EXISTING WELL? YES O NO M-
7. STATIC: WATER LEVEL Below Top of Casing: ET.
(Use "+" if Above Top of Caging)
8, TOI' Of CASING IS L FT. Above Land Sulfate"
'Top of cuing Iermio:nrd :l/,r below land snrlarc requires a
1:mialI a lu acrordame s,llh I5A NCAC 1C .0118.
9. YILLD(gpin): 6_ NI ET! to') TtisTR //fT
I0. APATER ZONES (depth): LZO) y'l'O
I I. DISINFECTION: Type C/fhOR/4/4_ Amount 3 Cjlm5
12. CASING: Wall Illicitness
Depth IJiamcicr or Weight,/Fl. Material
Ilion) O "Fo 67 Ill. 6 w SDR -2L p vc
From To Pt.
krolll Ill 1'1.
13. (i ROUT: Depth Material Method
From o Io2O Ill. Colycnr4 Akio Tv
Flour lo Ft-
1d- SCI(I:I:N: Dcplh Diaincicr Slot Sizc bInicrial
I Tom Tu II. in. in.
From To 11. in. in.
15. SAND/GRAV El. PACK:
Dcplh Sizc Material
froth Ill Ill.
1-1001 1 0 I"I.
16. RItMARKS:
� �Topographic/Land setting
IJliidge ❑Slope ❑Valley allot
(check appropriate host
Latitude/longitude of well location
Idcg ccc'minuloc/SccnndS(
Latitude/longitude soul cc:O(il'SOTopographic nap
Idleck best
Dlil'T11 DRILLING LOG
Ill om To Formation Description
O _ /3 S&» SANDY CLAY
1S Y-D___ LoSATy6R6-D SANDS r0Afs
YO 6o_ Swb S4Are
LOCATION SKEICII
Show direction and distance in miles from at least
Iwo Stale Roads or County Roads. Include the road
numbers imd common road names.
O
CO
.T1
rn
Cs7
CO
-o
W
c
IL, CONS-tkt'UC!illo)v S" TAN
I 3r
1
Submit the original In he I)sisiuu of NVater Quality, GrouudnMei Section, 1636 Mail Syr) ice Center- Raleigh, NC:
L-2-769'1-1636 PhmMr,5 19) 73.-3221, vrilhin 311 days. (iAV-I REV. 07/2001
I -'I I IIS WELL WAS CONSTRUCTED IN ACCORDANCE WI III ISA NCAC 2C, WELL
S, AND 111AT A COPY OE TIIIS RECORD I IAS BEEN I'ROVII)ED'10 11IL WELL O\VNEIt
.2-y-o3
'NA LURE ON CONSI RULIIN(i 11 Ili WELL DATE

WELL CONSTRUCTION ItECORD
North Carolina - Department of Envinnunenl and Natural Resources - Division of Water Quality - Groundwater Section[/
(- ON I RAC IUIi (INDIVIDUAL) NArIE (prlul) RA t/•DY Cnitiv.S CEfi'I'IF lc ioNN2I!v
U El 1. COST It.0 ll Olt CO\II'AN1NA\IE
O eg°lee GJe.I/ -Pat r-I^UG I'IIONE II flay) g37-wo O
S L\f E \\ I:LI. COSS1!RUC LION I'EltilITry ASSOCIA I'Ell \\'O IT:R\II'I
(ifaiplicablc) (if applicable)
I. \\'ELL. USN (Check Applicable I3ox): Itesidcnlial Ird' Lvlunicipal/Public ❑ budushial ❑ Agricultural ❑
Monitoring El Recovery ❑ Heal Pump Willer Injection ❑ Other ❑ If Other, List Use
2. \VEIL. I.00'ATION:
Nearest Town: 4114/14 k1/ County C�(pk 4 €
7e-2 -Teel %N�2T��
(,Street N:nne. Nlunhcl c, (lnnnurn ily, Subdivision, Lot No_ Zip Code)
3. OWNER: 3t"P, -r-I� J l Avery oPT
Address �1y %�• -/7--e b
(Slicer , r RNo )
//4AS✓�1oute 0 ,� .;-t9o2-/
City or Iowa Slalc Zip Code
(7s)-_ 3 9 — 805
Area code- Phone munhci
d. DAI N DRIL.LED1`.3/-en3
5. TO-FAL DEPTH: 305
6- DONS WELL. REPLACE EXISTING WELL? YES O NO ®Y y_ 90
7. STATIC \VA'LER LEVEL. BelowTop of Casing: ,50 F1'. 9n 3 D5
Topographic/Land setting
fatteldge ❑Slope ❑Valley ❑PIal
(check appropriate hoc
I.atiludedongiludc of %veil location
(deg) ccshnioul¢slsccondq
Latitude/longiludc source'.O(il'S❑Topographic map
(check box)
DRILLING LOG
Formation Description
tOL47NF-R69 SANDS TON6
'.O r.So &RAY S,CMTA
13EI'1'11
Erom To
D ,30
(Use "C' if Above Top of Casing)
8. TOP OF CASINO IS i FT. Above Laud Surliice
•Till ar rasing lei initiated al/nr bcltin land serrate requires n
carl:mcc In accordati c.silll ISA NC\C 2C .r11 Ifi.
9. 1IELD(gpn): ML11013OFTEST 49/R 227°T
I0. WATER ZONES (depth): 70 , 15U
11. DISINFECTION: rypcf`WLOTINE— Antonia -2 CvP3
12. CASING: Wall Thickness
Diarjtcler or Weight/PI. Material
Depth Front 0 ToS6 Pt chiA / -CChh
/ »VC
from TO H.
now in il
I3. (iROUI` Depth Mulcrial Method
110111 n 10 5o FI. c04--e Qc`76.,
horn To fl.
I4. SCREEN: Depth Di:uncicr Slut Size Malcrial
Flora '10 1I. in. in.
110111 TO FI. in. ill.
I5. SAND/GRAVEL. PACK:
Dcplh Sizc Malcrial
Flom TO It
From To PI.
3n 70
Jo T—
,R4Y ,$.CATI
,BAxicit 5 L-4T1r
LOCATION SKETCH
I
Show direction and distance in miles Flom al least
two Slate Roads or County (toads. Include the road
numbers and common road names.
W
16. REMARKS:
I L)O 11E12E13T CL:It110' TII
1)r!
,S'iiluitil the uriginalr': he D
L27699-1636. I'lydich 9) 73
Cr '
ION
ASHE\h LLt hi___,_ -ICE
1. 11IIS \VIiLI. WAS CONSTRUCIY.D IN ACCORDANCE \VIII I I 5A NCAC 2C. WELL.
S. AND 111A1.i Cf)1'Y OP Il IIS RECORD I IAS BEEN PROVIDED 10 II IE AVI'.I.L OWNER
3
SIGNAL URL OF PERSON CONS] RUCTING 111E WELL. DATE
vision of 11'aler Qualify, Grovn(Iwalcr Scclion, 1636 111ai1 Service Center - Raleigh, NC
-3221, within 30 days. (IW-I REV. 07/2001

268191
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Qualify - Groundwater Section
WElt. CONlDAD LOlt (INDIVIDUAL) NAIVE (print) i?ANDY iadLys
'IL CERTIFICATION
/1.2' V
\\Tall CON1 RAC FOR COMPANY NAME C 6\et2n kQe_ l.tJe.i� 1�Ri�.n / I'iloNE a l��f.7 J,37-O000 S.
SL\l 1: UTa.I. CONSIIRUC H ION PEItNIITa ASSOCL\T Ei1 WI) I'ERMI F#
(if applicable) (if applicable)
1. \WLLI. USE (Check Applicable Box): Residenlial CST I`lunicipal/public ❑ Industrial ❑ Agricullural 0
I\lonilnring 0 Recovery ❑ I !cal Pump Water Injection ❑ Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town:
M/SSiof")
County te.20
Isveel Name. Numhas//Community. Subdivision. Lot No.. Zip Code)
3. OWNER: € 1 e-/o l'Y, LAMh.y
Address P.n. ���' 11Cc,Cf
(Sa ccl or Route Nu)
,4Nb Re Les c 2T-in /
City or n sLAleLisZip Code
r\h ca code- Phase number
4. DATE DRILLED
5. TOTAL DEPTH: 4/0S
6, DOES WIiLL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: '32 ET.
(Usc "4- if Above lop of Casing)
8. T OI' Of CASINO IS / FT. Above Land Surface*
`Tap mf casing lermdualed al/or below land surface requires
'arl:mcc In accordance nllh I5,\ NCAC 2C.0118.
9. YIELD (gpnl): /b MGrnOD OF TEST p,
In. WATER ZONES (depth): ,2.20 , 75
I I. DISINFECTION: TypcL' 7 &?/Nd
12. CASING:
Allmon( ..G Cops
Wall 'thickness
Depth / Dian)cicr or \VciglVVfi. P)ah:rial
From 0 To� Fi. C't y ,. /g ¥ .57Z6L
from 0 To_jQZ ft. t_
From To Pt.
13. GROU I' Depth Material
I'ro ii To :2e _ IT_ Ce- nee-1-1— 9 /aalb2' I
Mont PC To Gr_ 1 Ft C>1 iNt$ 5'1�•
Id. SCREEN:Dcplh Di:mtcler glut Sizc 5
.l5 i STZLL
from l-o Ft.
From To Et.
in. n.
in. in.
15. SAND/GICAVEL PACK:
Depth Sizc Nlatcrial
From To I'1.
Front TO FI.
I6_ REMARKS..
Ntelhad
LrvMack' is
'topographic/Lana selling
012idge ❑Slope F7Valley DEW
Ichcck appmprialc howl
Latinate/longitude of well location
(degreecimimocs/secondsl
Latitude/longitude sconce:0G1'SO-fopogtaphic map
(check boll
DEI'FI1 DRILLING LOG
from To I ormalion Ucscriplion
D SS yhi-owf3/' C2AY
C05.sLk ��4U6L
_9( _SAND
'NITL frog I2IS1x
LOCATION SKETCII
Show tlircclion and distance in miles from al (cast
Iwo State Roads or County Roads. Include the road
numbers and CO111nmll road names.
h£:01WV £-833£0
I DO I II REDY C1311 i f
CONSTR(IC I ION Sal"1A
I IAT 1IIIS VWEI-I. WAS CONSTRUCTED EI) IN ACCORDANCE Wlll I I 5A NCAC 2C, WELL
ARDS, AND IIIAT COPY OF THIS RECORD I IAS BEEN PROVIDED 1(111 Ili WEI.I, OWNER
GNAIURE 1' PERSON CONSTRUCT) ING 111E WELL
DATE
Submit the mi)ri n:hl to the Division of \\'clew Qpalily, (: rounthc:rtcr Sccliml, 1616 Nlail Set ict• Ccnlcr- Raleigh, NC
27699-1636 Phone No. (71y) 733 _3221, within 30 days. GW-I REV. 07/2001

268192
WELL CONSTRUCTION RECORU
NrorIh Carolina - ucpal lineal of Environment and Natural Resources- Division of \Paler Quality - Groundwater Section
\\ I:LI. (O\'I It WI Olt (INDIVIDUAL) NAME (prInO �' / CON/ NS CERTIFICATION R.!_io3 7T
\\I:I I. CON RAC IIIIt COMI'ANV NAME _ E€I .o fKea 1.(—)e11_ cbal I t I AD, I'IIONE k f53}'S)S$ 37 -Z o 3'
SIAlI. O'EI.I. ('O\S I RTC IION PEItMITN_ ASSOCIAT VD \\'O I'EltMl 111
III nppliea6le) (ifapplicablc)
I. \\'EI.I. USE (('heck Applicable 130x): Itesidcntial gr.-Municipal/Public ❑ Industrial ❑ Agricultural ❑
Nlnuitoring ❑ Recovery ❑ I lent Pump Water Injeclion ❑ Other 0 If Other, List Use
2 AFE1-I. 1 ()CATION: Ncal csl Town. —4 bP S /l County V--J12R�k'Le_
NGo iv ✓91 Yo C'o✓e
Kneel Nlnnr m,bci< ('ouunnnly, Subdivision, Lot Nu.. Zip Code)
.1. O\\'NIiR: L)AIULI 474/5
:\ddless Po l3cX
ISnecl or Rome No.)
nibP-e tc_75 , CC 715 Of DI.1' 111
Anon toile- Plane number
.1 DA'II1O1211.I.I:1D/-�-03 C 10(3
1 o 1ogralll 'c/Laud selling
❑Ridge PSTope ❑Valley ❑Flat
I uIcrk aprroprialc ho,)
I atitudcllongiludc or well location
'degrees Y ,i l iies'scconds l
Llll ll lldl'/ InIg 1111dC sirircc:❑(H'S❑Topographic map
(check box)
DRILLING LOG
Formation Description
k'4/.2.0 ✓ 54A/QST0'b
&)J4fllfRr-ir ,Refs-w sL4rt
13�e 4-C,RI4Y 7E
c or,,,„„ SIelc Zip Code Titan Tl)
(Sas)32/- 'Y593 8
S 5 S
5. TOTAI. DIii'll l: 4;0 ,
6 DOES WILL RI.PLACE EXISTING WELL? YES ❑ NO F4'
7 SFA'Il(' WATER LEVEI. Below Top of Casing: 7O____EI.
(Use "1-" it Above Top of('nting)
R 1 O1' OF CASING IS j FT. Above land Surface"
'1 np .f rs,iug Irrnliwaled al/or ',chow land Surface requires
Infs. 1 aI IbIn¢Dc (hgl larmc.): -d_%v_h —I5,\NlNICIA}tCu2CD11o1f.rEstRI-1t
WATER ZONES ()eph). 280 ------""-----
_._--
11. I)ISINFN('T
12. LASING..
Illml 0
horn
'I'lll_.
13- ( ;ItOLIr:
Iloin L?
I nun L)0
1.1 SCREEN:
ION: •fypcL'4/GC>,e/h'4 Amount _,j 0_12iC
wan Thickness
Depth Dianulcr or \VcighVFl. Material
To /t7g FI. 6 it SDk�1 P't/e,
To FI,
Io_--_..__..
Ucptll Material Method
To 2 a II. C&NCk_4.J L&@Y,T
it, /0 8 Ft. Cunt- At s
Depth Diameter Slot Size Mnlcnal
I loin Tn I'I. in.
Erma To FI,
15. SANI);(iRAVI9.I'A('K:
Depth Size
I win I o 1-1.
h(1111 111 LL
Material
16. It[NIARKS:
LOCATION SKETCH
Show direction and distance in miles Iron) at least
Iwo Stale Roads or County Roads. Include the road
numbers and common road minus.
O
w
m
co
w
A
0
w
Cr.
O
Cr,
1JJL)J1h¢brtV ('I R Ilrv' I I IA1.I1115 WELT, WAS CONS FR(JCT FI) IN ACCORDANCE WI III I5A NCAC 2C, WELL
(;UNSIRUI II ri). SIKrW,t7\ItISS. 1)11IAT A COPY OF THIS RECORD IIAS I3ITN PROVIDED TU 111E WELL OWNER
fie_ / -c 03
SIGNATURE 01: PERSON CONS RUC I INC ll II'. \1l(I,I. DAl
Sulm)il the original to Ih Division of \Paler Quality, Groundwater Suction. 1636 Mail Service Censer- Raleigh, NC
- 276991616 Plane No, ('119ii733-3221, within 3(1 (lays. G\V-I REV. (17/20(11

WELL CONSTRUCTION 1tECOiW
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CON TRACI OR (INDIVIDUAL) NAME (print)
WELL CONTRACTOR COMPANY NAME
STATE SVELL CONSTIIUCTION PEMIIt1
if n r Iicnble
I. WELL USE (Check Applicable Dox): Residential V Municipal/Public L7 Industrial El Agricultural ❑
Monitoring El Recovery Li Neat Pump Water Injection ❑ Other 17 If Other, List Use
TopographicJLnnd setting
❑Midge ❑Slope ❑Volley OEM
(check nppropriale box)
Lalitudtllongilude of wet! location
3r,oG r7_sr_8s_
(degreeJminule,secnndt)
Latitude/longitude sourcc:DOPSfTopograpllic map
(check box)
pRILL�01 1,00
Formation Description
2. WELL LOCATION:
\( ,
1' County --
earesl'1bwn:'(� \F�1� �_
�lY��Cf �H t2 e_ _----
(Street Heine, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: OYTt\r�'\,�`
Address
(Sited or Route No.)
City ur To.vn Stole
•
p
olo L r. .
Zip Code - Front To
(— )
Nca cote- phone number
4. DATE DRILLED . 5. TOTAL DEP VII: '11 3�' ----.---
6. DOES WELL REPLACE EXISFINO WELL? YES Li 140 Ld—
I"I'
7. STATIC WATER LEVEL Dclor`UfeTop uITAbCasing:
Above Top of Cn+lna)
S. 'f Or f OF CASINO IS I
FT. Above 1 .nod Surfnce•
• Top of ndne Ia ndnslyd st/nr brlore lord 'white rrqulr er
•
▪ silence In rccurdxnre whir I5A NCAC 1C .01 in.
9. YIELD (gpm): IS — METHOD OFTES T Q__
' CERTIFICATION 1.24yU
rIIONE 1 r��yy-
ASSOCIATED WQ PERMIt1
if e r )Iicthic
10 WATER ZONES (depth): V "?er,Qt74.12:1,32-0
268418
ow I • t miles from at least
;a )l Wallll Thickness
-- two Stale Roads or County Roads. Include the road
II. DISINFECT"ION: I'',c thickness
12. CASING: Diameter or Weight/Et. Material cumbers olyd conunon road names.
1o'tl—E.,io .ilK T`D-- -- Pry
To Ft
Fronk_ r
Fronk_ J
Frollr_. __ _
Fran__ 1o_ FL___---- Method
Pam �--
13. GROUT: Depth Mfr crinl
TuEL - '..c2i-i_
Tr, _ Ft.______
— --
•
Depth Diameter Slot Size Material 'In
FL
ht. - in. _
— _
From__
14. SCRPFN.
ftolIl
---In.
Pronr___
To 1I.
15. SAND/GRAVEL PACK: Sire
Depth
Frrnn To Ft.
From To 1'I.
— m.
Material
.1a_c_A1101___Ligncll
Show direction end distance u
-To
n
v o
in Pee, 1,4fce f"'SS:an
5Ckoe t
1111S WELL WAS CONS I RUCTED IN ACCORDANCE WTih l I SA NCAC 2C, WELL
S, AND "I HAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED TOME WELL OWNER
—f0 0
ASNcV' LE f
1 (--
G l :OFFI E NA SIGTURE OF PERSON CONSTRUCTING TILE WELL DNIE
ue0AI_
SuInn11 the or Igl00nn1 to the nlvI Ion of Wnlrr Quality, Gr^'!r1awnler Section, 1636 MMI Senlve Center - Raleigh, NC
dw-I REv.ol/znol
116ao-1636 phone No. (919) 33-3221, Irlrhln 311 tiny!.

268422
WELL CONSTRUCTION RECORD
North C tolina - Department of Environment and Natural Resources - Division of Water Quality Groundwater
Se t1011 �
�'11l l \ N N-L Iti
c
55'ELWELLCON IRACIOR(INUII'1lrUAL)NA6fE lPrInl ) CEouGJ11 C1 f, 1r A _ f110NE N
WELL CONTMCIOR COPIPANY NA61 F- A550CIMF.1/ WI) FERMI �—
STATE Sr F.LL CONS rnVCfION fEMII EN if a 'Kathie
if rlicublc
I. WELL USE (Check Applicable Box): Residential fa- Municipal/Public ❑ Industrial ❑ Agricultural U
Monitoring ❑ Recovery U Ileat Pump Water Injection U Other L7 If Other, List Use
Topographic/Land setting
['Midge USlopc ©/nlIcy Mint
(check approprlale boa)
Latitude/longitude of well lo:ation
AJzs t6•i57i.)13 ; ,88
(degree✓nil nula/scc ods)
Latitude/longitude source:UGPSL7Topographic map
(check boa)
!g . pRILLIUSL.OG
prom To Formation Description
2. WELL LOCATION:
Neatest Town:
(Sneer Name, Numbers, Community, 51111(1h/ ion, lot No., Zip Code)
r
3. OWNER
Address
btsjati1(Snee(1'1-''of Route No.) J.5 `0 i
City or Torvn
State Zip Code
( '' )-
Area emir- fbone number
4. DATE DRILLED
5. TGTAL DEPTII:inSiai__--- --
6. DOLES WELL REPLACE EXISTING WELL'? YES IW-
7 ntAtit' WATER LEVEL Below Top of Casing:
(I Dr "e" If Above Top of cRitor)
8. TOP or CASINO IS _ i_.-- t F. Avow land Sulfnce'
'Tor of cailne terminated stior bdon laud am tare requhn a
v silence In accordance nIth 15A NCAC IC .011 N. q
9. YIELD (gpirl): ___Co___ METHOD OF TEST I-{ I�
10. WATER ZONES (depth):
,M AmountI. DISINFECTION: Type Wall Thickness
12. CASING: Depth Diameter or Weight/Ft. Material
1
,
Erotlt — To2/' FL -�-=I %
Elam l o Ft.,
from To Ft.
13. GROUT: Depth R
f rom_ l 0. 0--
To_ Ft._ — Materiel
Dcplh Diameter Slot Size
'In Ft. in. in.
-- - — LI it in.
To__
15. SAND/GRAVEL PACK.: SizeMaicrinl
Depth
From To Fl.
From -l-_
County(
From
IA. SCnpFN:
Flom
Eton
R�
I CI ONSfRUCT10N STAN
, MAR LU23u3'
r_---,-
GROUNUVJFSEri SECTION
ASFif1/11 0ft(16IC1Nlnl1@Ffteate 1)1
1)699-1636 Phone No. (919)733
Mal
Method
CL
p—ON KE 41l
Show direction and distance in miles from nt least
Iwo Stale Roads or Comely Roods. Include the road
numbers and corml1On toad names.
iph5,0,7Qd
0
0
co
�n
i o
0
0
kr.
THIS WELL WAS CONS I RUCtED IN ACCORDANCE WI711 I SA NCAC 2C, WELL
, AND TIIAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED TOME WELL OWNER
----------
SI 'NATURE OF PERSON CONSTRUCIINC THE WELL DATE
7Won of Water Quality, Groundwater Section, 1636 Mall Service COWr- fRVg071 C
-3121, within 30 day!.

WELL CUNSTILUC,'I iON ItECORIJ
268419
ooil lieq
Nollh Goblins - Ucpallurenl of Environment rind Natural Resources - Division of Water Quality - 0iouud�ntcr S"r,twit
n
nn r gON 1 7
WELL CON RAC1 OIL (INOIP'I UUAL)NAPIF. (t',I) sPIIONE II 1
cen1IFlCA7rUN
tr I.LE �� cjr III Vtr'Jt---
tvLLI,CCN! !!ACI OR COMPANY NAME \ty •¢gnrlAT o!"°" r•ERNIIM _.— ----�—
SPAtE\t'F.I.LCONS IkUICriGr7 fErL"!Ifr—. --�
if o I d icnblc
ifs ',tickle -
Applicable Ito: : Residential Itvibmicipal/Priblic ❑ luriusiiict 1-1 Aglicullutal ❑
I, WELLdtUSE (Check AI I )
Monitoring O Ilccuvcny U Ilea( Pump Writer Injection L7 Other O If Other, List Use
2. WELL LOCAnI ION: 7
Iopoginp11d,n,d setting
Cal es 10„ll:_(OIII)❑Ilidge JSlopc lVnllcy O
f lat
VI-XTLln-R1(check nppnndo" hm)
($ueel thine. Nunhne, Community, Subdivision, Lot No., Z,Ip CI"le) Latitude/longitude of well location
L/3So61y ILEll•
(,t rneetnlnuleifsmode)
nlongitude source:CIOPSL)iTopoglaphic neap
(check box)
Houle No.) knaLtL9 1.12V
pun tion Description
3. OWNER: \i
Address lQ 9C',-¢
rn\Y (Sl¢cln
�r .ilyaI"M Zip Cole
Cllyol "
Alf. cnlr. flume number . •i. DM DIIILLEUi 3(_ ti,j
5. Ivrnl,UlTrn:_33fS- ___----
6. DOES WELL REPLACE EXISVINO WELL1 gYESS 0 NO (u
1. STATIC \VA"f GR LEVEL Uclor(IJ r l'i f CTISIr Aboveinn nl cn,b,p)
B. TOE' OF CASINO IS 1 __ FT. Above Land Sul fnce•
Err rr endue Inmin•Ir,l dlnr Inlon lend nnl•re 'wilt. •
., Wince In .rrnrd.nre nllh I,A NUC 1C .01111 _ to •n
Q. YIELD (grin):—--—MIVIIl0DOP'TESr --_
----
IU. \VATGIL ZONES (depth): —_
-n+ Amount
I I. DISINFECTION: 'I'yper I vt \gnll'Ibickncve
12. CASINO: Depth DDiimjucll rrr or Weighat. h1nterinl
4m1>�.- Floe It In _
From To I' I' — Method
e tth hint n I
13. ORou r: Depth r rt.��� glom - Io — —
new_ Dinnicler Slot Sire 14. SCREEN: Depth in.
its: FLin.
Flinn-_ -- - I I. il:. in. _
hunt_ ___ fo__--
15. SAND/0RA\' , PACK: Sire htnlcllnl
Depth
To lit.
To
from
nom
I@Ju-1ARF�_
1 DO HEREBY CEIttlfl
MARS1Al&r r,Ru l A
11
ReLo—
UUL'UI
1Ioill .to
e
LQ_GM I V NLaK iiici i
Show direction and distance in miles from n1 lens;
Iwo Slate Roads or County Roods. Include the toad
IIu11111Ma nut rnnunon mdd nmuna
T 111IS \e EE.i• WAS CONS' RIICI1 l IN ACCORDANCE W I111 I SA NCAC 2C, WELL
)5, AND MAT A C0I'Y OF MIS IU?CORD IIAS BEEN PROVIDED 10 111L� WELL OWNER
OA tit
GROUfdDt'J";-..L' =•EJIiOitl
5I0NA1UIlLl UI' PERSON CONSIRUCIINO THE WELL
!Weigh,
NC
ASHEVILLE REGiLfSAL OFFICE
Snhm:W
ll the origin lo the WIon of 3Vn ler Quality, Groundwater Section, 1636 Nall Service Center -!Weigh, N -
11610-1636 Phone No. [phone], n.lthhl 311 tiny,. OW-1 I1LV01

268420
con' run• ������ /
WELL CONSTRUCTION RECORD
I C I rrnl nod Ilnlurnl Ilesourcne - Ulvl+Ion of Wain! oualny - rhound/,npu sec -lion
110rt11 Ca Service
- e Center
0 -nv Inrtn .
1636 Hal Servlr-e Cerrler • nnlelgh, N.C. 27699.1676 Phone [phone]
WELL C[7
WELL Cull IHal 1011 CEr1IIrIcAll[JII n: c )40e
SIAlE Writ. COI1SIIlUC11011 PE111411n:
Indushlalt� AgticulWral U
I. WELL USE (Check Applicable Oo1)t fla91dan11al I Municipal U
hecovnry LI
I leal Pump Water In(ocllon LI Other LI II Other, Llsl Use:
2. WELL LOCAL ION: (Show skaldal Ilto Location below) 1 IV //E/� ,_F,
_ i.. L �[
�i __ _ .._ ._---- UI111_UI IG LOG
L!/-n�--- Goy h nr Su6dlvlslon end 1 nl 1 - --('
and Ilamn rind !lumbar!. CaJnllydly IY',���1 rro,n la
-i'—
.-2-_— S—
S OWIIEI1
Address L _?� ai lar"l;TIo
Ally Of 7 o.11
Stale
OAl E un1L1 E0 /-
4.
5. IOIALDEN II s---
E CU11111GSCOLLEC1El) 1'V5I_ I IlO --
11O1
7. uOES WELLf1EPL/lCE-: CXISI IIJ[i, olCasing: LSO r 1 I
O. SI Al IC WAI Ell LEVEL Below lotP. l OP Or CASING ISI FF.Above .
zip Codo
(Use •r• If ALove lop nl Cadnol
•T
I end Sullnco•
_ -.--- op of d+lnp i,, min+led War h,Iow Laud eutl¢e 1equLe+ a v.tlu,ce In scorn-
--
dance wllh ISA IICAC 2C.01 18 ME 1 l IOU Or 11-5 f
10. YIELD igloo): 1-
11. WAIEI1 ZOIIES (depth):
12. CI ILOnlrlA1 ION: 1 /po
13. CASING:
Amount -�7---
\7.+II 1111,1,nr s+
pn0l11 Ula,,. wlor OFWaU,r..z� 2-C-1--
flan, —cam -lo — -
How--.-- to
PI. --
Cron, 10 r L ----
14. UI10U1:
From
Clow
15. SCf1EE11:
Uepll,
From l ._-- I
Faun
on,
r lonl __lo_—r1.
16. SAIIUIUnAVEL PACK:
Depth
1AI1I(5:
L II0CEAIr44AT
COI s1nuCton S1ANOA11u
011I(p(-I�I�4LELEr lilifr0FF CE
Wad
11011111 r
6=-
,i� 10
in r 1.
Mal ilal i Mulllod
Ulanlo lnr Slot 51ro Malol10I
In. _ In.
In. -- In. _
Site
Ivinlullel
Mani loricg U
DE: I I I-_ - -
Uea_rInrll
-- ll ndIrdldonml !NKr! it irrn1 rl lrso Irmo: of Ivn'
_--- _ -
LOCAL IOI1I CO_
(Show dlrecllon nod d`s'mlcn Lan 21 Inatf fi:'1n
Ilondn. or 01her pout'
ELL Wn+1Ct,l1S1nUCIE01llAGCOIl0ANcr_ WI11113A ICA.CY,YlEtt
11IAf ACOPY or 1111s nECOi%0Iins UEEN r f10VICEo 70111E 71:=L o`I•'EE
/ ,lorinl[lI%c orrr119O11 CalsIIufllnn Iv; .0 F11.
oft r
Sub O od0hnl I0 0ivldon of Waier OVelliy.0ntmO• alit Src-c0 wIU In y1 G3 ys
Cn.I FIE v. 1.n
0
0
-_,
rn
cv
rN)
0
O
W
J
c

268423
2. WELL LOCATION:
Neatest *Iown! 11 �l\i
\IPY'.GfrA
3
North Carolina - Depatnncn o 'ITV _ n n CERTIrICA7ION II
ASSOCIATE,» NO JERMITN
(iPopRlicablc)
WELL CONSTRUCTION RECORD
t f E ironment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CON MCTOR(INDIVIDUAL) NANE (print))
WVELLCONTRACI OR COMPANY NAME rl'l �`CC r11UNE • f�-i �j,-Z`'i ci�
�11 CC ...
STA1E WELL CONSTRUCTION EEIUIIIII
In pplicnblc
I. WELL USE (Check Applicable)
Dux): It Residential tA�Mnnicipal/I'nblic ❑ Industrial ❑ Agricultural CI
Monitoring ❑ Recovery
❑ liens rump Water Injection ❑ Other d If Other, List Use
Topographic/Land setting
I]Itidge ❑Slope [Walley ❑Flat
(check epprnprl•le box)
Lslitude/longilude of well location
County_al-Q CC L F L
(Street Herne, Numbers, Community, Subdivision, Lot Flo., Zip Code)
OWNER:
Address
(Sheet or Roble No.)
ynrT n
SIAM Zip Code
,
(_)
Ares Pale. Phone number
4. DATE DRILLED
5. TOTAL DErI
6. DOES WELL REPLACE EXISTING WELI,7 YES O I-
7. STATIC WATER LEVEL DclowU �ope eoff asinve gnr of Casing)
A. TDI' OF CASING IS I__ FF. Above I.mld Sutfnce•
•Tor of (Ong Inmhuled •ttor below bind PIP/ race requites •
whore In •ccord•na whit I5ANCAC MEOD OF 1 EST t
9. YIELDLD (gm): _
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. CASING:
Amount
Wall thickness
Depth Diameter or Weight/Ft. Material
Trr�n_
Flom h
From 1
13. GROUT: I
rroln_LZ—•
14. SCREEN:
Flom
rtom
I5. SAND/GRAN
From
From
auoM
(degrcedminulesseeond )
Latitude/longitude source:00PSC1Topographic map
(check box)
DIULLiM LOG
Foftnation Description
3-rt.1.9 ,2 sow Q —
Ft
Depth
fo �� FI.
—
Depth Diameter
To Ft._in.
To__
EL PACK:
Depth
To
l.o
r t -H ERFBV CLRrlf
C0NS1RUCTIONST
I 3 903
il
Size
1L_
Ft
Method
Slut Sin Material
in.
in.
Ntntet inl
Data
FromTo
iION Y_C�I
Show direction and distance in miles From at least
two Stale Roads or County Roads. Include the road
numbers and common road names.
0
Fri
0 -
T 1111S WELT, WAS CONS IRUCfED IN ACCORDANCE WFO1 I SA NCAC 2C, WELL
5, AND TIIAT A COPY OF TIES RECORD IIAS BEEN PROVIDED TO 111E WELL OWNER
,yy DATE
MAC �cu
SIGNATURE OF PERSON CONS 1 RUCIINO TIIE WELL
5` CTTION the )Melon of Water Quality, Groundwater Section, 1636 Mall Service Center Raleigh,
C
ASHE I16gQ-1616 thane
No. ( 133-3I21 wItldn 30 days.
116so-1636 Phone Na. (919) r

WELL, CONSTRUCTION 1tMAii LI
North Carolina - Department of Environment and Natural Resources - Division of Water Quality OroundcERTIF waterCA Nrliur, 7 �
WELL CON I RACTOR (INDIVIDUAL) NAME (Print) %,-1
WELL CONTRACTOR COMPANY NAPiE V IIIC II T
ASSOCIATED WQ FERMI IX
5 to TE WELL 'Rabic
CTION PEM11Ta if ilicablc
if a dicnblblc
WELL USE (Check Applica
ble I Ic Box): ) Residential O Municipal/Public IJ Industrial O Agricultural Elk"
2. WELL LOCATION:
Nearest 'Lown:jN�S.14 —
(Street Name, Number, Community, Subdivision, Lop No.. Zip Code)
6 )
3. OWNER:
Address
Monitoring O Recovery ❑ Ilcat Pump Water Injection 0 Other ❑ If Other, List Use
Topographic/Land setting
['Ridge ❑Slope 17Valley ❑Flat
(check Appropriate boa)
Latitude/longitude of well location
rvti/e- (degreeshnlnulesiv—inds)
Latitude/longitude source:001'SM upographic map
(check box)
ELRILLfQ_LDQ
Formation Descriplion
City or Tow
Area cane Phone number
. 4. DATE DRILLED /— » 110--613--
5. TOTAL DEPtIi:
6. DOES WELL IU:PLACE EXISTINO WELL? gYES�u (D
7. STATIC WATER LEVEL Dcloa(Use P4uif Above Top of CAeiog)
n OF CASING IS ___I -._-- F . Above Land Surfnce•
8. TOP- .-I..,d .urine requires •
•-I'Ap of exiting Lrminaed .u,., .•..... tt
variance In •reordeiice with ISA NCAC IC .al la.
9. YIELD(gpol): --METHOD OFTESTAPS__—
10. WATER ZONES (depth):
(Street or
CountyLjL1.
268283
Stale
I. DISINFECTION: Type
2. CASINO:
Depth
�Front�-- I'o
Ftam_
Tn
From_To--
a
Zip Code
Mai
Diameter
Ft. /r 1S
Ft.
rt.
Amount
Well "Ihickncss
or Weight/tit. Material
Dv
M tonal
13. GROUT: Depth
d
From —Tom —Ft. n ci
To Ft'--
Diameter
PI in.
110M -
14. SCREEN: Depth
Item
From To
15. SAND/GRAVEL PACK:
Depth
From To FI'.
To FI.
From
5:
1; r--40-TIERED.
rCONSTR CTION ST
To
ASLH Stchcal( the osiglh''l[Io Ih
27699_16T611bonc No. (919
Size
Method
Slot Sim Material
111
in
Material
PEPTTI
From To
42cA;UN SK_GT4i,
Show direction and distance in relics from nt least
Iwo Stale Roads or County Roads. Include the road
numbers and common toad names.
O
w
v
a-r
i J
Fri _,
cn
m
G
IAT T IIIS WELL WAS CONSTRUCTED IN ACCORDANCE W 1111 I SA NCAC 2C, WELL
RllS, AND TIIAT A COPY or TIIIS RECORD IIAS BEEN PROVIDED TO TILE WELL OWNER
SIGNATURE OE PERSON CONS "IRUCTINO TIIB WELL DATE
Division of Water Quality, Groundwater Section, 1636 Mall Service COWr� IRaaleigh, C
733-3221, within 30 days.

268421
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and
Natural Resources `DCvfslon of Water Qualify Groundwater
IF lCAT10 Section
n�
WELL COOT MCTOR (INDIVIDUAL) NAME (print) e" " r 'ON 1 V e)--`r 1>
w'ELLCON TMCIOR COa1f ANV NAME
%' �1:� 1�PI l Li 117 1�-- fCER1 a ,y---
ASSOCIATED +4Q EERMI TN _,—_--
STATEWELLlicablc 'RUCTION f EMllfir if a,rlicoble
if n „lica
I, WELL USE (Check Applicable Box): Residential Municipal/PDbuic 1.7 industrial ❑ Agricultural ❑
Monitoring ❑ Recovery EL (lent Pump Water Injection 17 Other L7 If Other, List Use
Topographic/Land setting
Dltidge OSlope ❑Vnlley Mal
(check npprnpdale boa)
Latitude/longitude of well location
(degr¢edminul(i(econde)
Lnlitoddlongilude sourceC/OPSCITopogtapllic'nap
(check box)
PlICILLI QLOG
Formation Description
2. WELL LOCATION' i P- E"<2'l!r G'
/� its County
Nearest'Iba'u:
(Sheet Name, Numbnr, Community, Subdivision, Lot No., Zip Code)
3. OWNER:
Address
4.
5
city or Town Stale
;;de 5
roc
(Sneer or Route No.)
led _
Zip Code
(_)
A,ra code- rhone number/ /6, -C A.
DATE DRILLED
T OVAL DEPTIL_ C2D__
DOES WELL REELACE EXISTING WELL? YES U NO
rt. 6.
7. STATIC WATER LEVEL clo+(lie P o'IfAbovleTop ofCming)
g. TOP DE CASINO IS -_l Z _ rr. Above Lnnd Sutraco•
•-I op of (obit terminated ardor below land 'Inflict require, a r
vo,l'nte In accordant, nl1b 15A NCAC 1C .011(1.
9. YIELD (gpnr): —�--- METIIOD OF TEST
10. WATER ZONES (depth): /�
Amount
II. DISINFECTION: "Type__�T�f-- Wall 'thickness
12. CASINO: Depth, Diameter or Weight/Et. M
moat .-- ToLtL/�� pqJ_r1. l-2-s- --/S.Y ,
prom "10 Il _
Frolb___
13. GROUT:
-
Prom U
Prom To Ft.__-- - ' M. SCREEN: Depth —
r Diameter Slot Sim
_
From Tr. in.
_ I L_—
i
Ilm„ To
I'(, ir!.lr. in.
15. SAND/GRAVEL PACK: Sim
Dept",
Prom ____T o
prom To
o� E 6killAR S '`'
,��rII DO HEREBY CERTI
k MHf�tISSR3IC IR/1 ST
It
rl.
Material
terinl
To --- Ft. M thml
Dcplh dal I-�'{�Uh�
To F1. , L' G,"
Muter ial
Prom To
ION SKGll
Show direction and distance in miles from at least
two Stale Roads or County Roads. Include the road
numbers and conunmr road names.
o
-11
,n
O
T.
0
W
T 11113 \VELI, \VAS CONSTRUCTED IN ACCORDANCE Wall I5A NCAC 2C, WELL
38, AND TIIAT A COPY 0F1115 RECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
1C I- I Li 02
WOE
GROUPr
SIGNATURE 1' PERSON CONS TRUCIIN01IIE WELL
, H r ;E 'i0id
ASNEVILLE P.LG _ or malt G\Vr1 REVgh,NC01
lm I the original to the Division of Water Quality, Groundwater Secllonn 1636 Mall Service Center - Raleigh, N
116ao-1636 Phone No. [phone], within 30 days.

WELL CONSTRUCTION Itb%.CAW
North Carolina - Department of Environment and Natural Resouurces - Division of Water Quality - GrCEoundwater r Se Ptiol
WELL CONIMC2OR (INDIVIDUAL) NAME (print) �Al'm1Cs `� J
PHONE 0 (raS (6- 7 L99-1
R'ELL CONTMCI OR COMPANY NAME
ASSOCIATED WQ FERMI fM
5 IA ri.:: ELL rnNSTRUCtlON fEMII FH (if applicable)
(if applicable) _
I. WELL USE (Check Applicable Boa): Residential ILl' Niuiiicip.^.I/rnhlie II Industrial 0 Agricultural
El
t,tonitorMg ❑ Recovery U Item Pump Water Injection ❑ Other O If Owcl, List Ilse
Topographic/Land selling
ORidge 0SIope lVnllcy OEIat
(check errrnpdate boa)
Latitude/longitude of well location
26827
2. WELL LOCATTI2N:
Nearest Tor\IC
County
(Sued Name, Nwnben• Community, Subdivision, lul No., 7,Ip Code)
J. OWNER:
i
Address �'\\'f���`�w�N'
(Su eclor owe o. r 1'1 ,)
City or Town State
()"
NA Tale- ThoRIL
4. DATE DRILLEDED,
5. TOTAL DErrn _Cn11z _----
6. DOES WELL REPLACE EXISTING WELL? YES U NO U
7. STATIC \VATER LEVEL Below c Top of asing.bove Tor/OOm1 g) ET.
(Us
of C
8. TOP OF CASING IS
IT. Above Loud Surface•
•1er of coin! terminated laUnr bolo* Imdaortae, rtquho
•
vulmce In .ccordanre *MI ISA NCAC 2C.011!.
9. YIELD(gpmm): METIIODOETEST/ 1%
10. WATER ZONES (depth):
II. DISINFECTION: Type
12. CASING:
Depth
Pro,
Fr run__ 10 Ft.
Fro❑ To It. —
Depth M icrinl Method
13. GROUT: row, Ft. LLLL� -- — l'S ILCC'
From__ To Ft _______ ----
Diameter Slot Sim Material
14. SCREEN: Depth irl. in.
from In —_—PI.
f,rm
To It in. in.
15. SAND/GRAVEL PACK:
Depth
from To fl
to
f
Zip Code
(degreesmndnutdsecnndn)
Latitude/longitude source:OGPSC1Topographic map
(check boa)
pRJL1RG LOG
onnation Description
from
__RCAIARKS -R __
, r WELL
• *n r'1IIATTHISWELL\VASCONSTIIUCrEDINACCORDANCEWIT1IISANCAC2C,
a 6O H CONSTRUCT
$�,( Y j U I II AT A COPY or THIS RECORD IlAS BEEN PROVIDED TO TIIE WELL OWNER
CONSTRUCr)N S`jfiI{ 'rRDS,- / (o?
SIGNATURE OF PERSON — CONSTRUCTING TIIE WELL HATE
Submit the orlglnat l0 11 a Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh,ghgb,NC
NC
—TTCW T6.361liondNo. ) 7JJ-3121, mrttllhm 30 days. G\Vrt REV.07/2001
Amount s
Wall Thickness
Diameter orWc6VfL Marerial
Dv_
ft./i2S
It.
Size Material
pE�..
from To
O-- (D
1OCA.flQ SKETGi1
Show direction and distance in miles from at least
Iwo State Roads or Coady Roads. Include the road
numbers and common road names. e' o
C— "-
>~a _'? 0
CO
0
W

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natu I Resources - Division of Water Quality
WELL CONTRACTOR (INDIVIDUAL) N ANTE (ring ee
//e r ill n/rll ily
1VELLCONTRACI OR COhIrANT NAa1F,_ --- WQ PF.MIITA
5 FATE WELL CONSFRUCTION r ERASSOCIATEDAIITA ifa sl WO
if n licnblc vable
WELL USE (Check Applicable floc): Residential C rvluuicipal/Public L7 Industrial 0 Agticullural ❑
Monitoring ❑ Recovery O Ilent Pump Water Injection O Other O If Other, List Use
2. WELL LOCATION: zw3
Nearestiorvie /7//d!
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: /�e/ £ (rock-4 r a
Address /./ C-st- (Sheet or Route No.)
1_5(7 `q
CIy or Loan Stale
Area code- rhone number )G CJ
d. DATE DRILLED _L L
5. TOTAL DEPITI:_ 6. DOES WELL REPLACE EXIST 'NCI WELL/ YES EJ 110 rl-
7. STATIC WATER LEVEL Eclor(U e of Casing: op•
of Cneh,g)
L Surface8. 'FOP OF CASINO IS /L —
FT. Above Land Surfac
top or nJne terminated aUor below land swine rtquhn
variance In orcortl ace with I5A NCAC IC .0115.
9. YIELD (gpm): 7S__ ME`IIOD OF "rES1 ii_! —
10. WATER ZONES (depth): �A
County C,1id11ft
Zip Code
268276
Groundwater Section
CERTIFICKFION A 03
?norm 2-LLT2:229_1
Topographic/Land setting
[Midge ❑Slope ❑Volley ❑plat
(check appropriate box)
Latitude/longitude of well location
(degreea/ndnulcatax^nda)
Latitude/longitude sourcetIGPs0 ;opograpitic(check map
j)RILL�(zLOG
Formation Description
.r.l Tf7` Amount �!6°2
II. DISINFECTION: Type /�—\Vnll'1llit Jjr_
12. CASING: Diameter orWe1gliVEI. Material
Depth ra /
rrorlL�— Tn�1=- EL 4 _ ,/1�'. 3Z
FrontV2 To �97 FI. L-AC /�7
From To FL_
13. GROUT:Depth Mq( erla Method
rr01n_12___ To /__rt. = �
C
;—L--c —
rt.
--
Prom__ 1 o Material
Dintnelcr Slot Sire 14. SCnrFN: Depth in.
Rom
To Ft. in. rrorn — -- in.
7o I t. in.
15. SAND/GRAVEL PACK: Material
Sire
From To Ft.
From To Ft.
1-6. REMARKS;
VDO I IEREBY CER u?M 111
CONS1RUCTIONSTANSA
MLLlll
From To
L 2411/
zip 4
—ION�1
Show direction and distance in miles from Ica
two State Roads or County Roads. Include ritt
numbers and conunon road names. Z
Ca
2rn
rrn
ra
A
0
t.)
T 11115 WELL WAS CONSTRUCTED IN ACCORDANCE W1111 I5A NCAC 2C, WELL
S AND,JIIAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED TO TILE WELL OWNER
/ �,�i- 03
IGNATURE OP PERSON CONS1 RUCTING THE WELL Subtnit the orlginnl to the Division of Water Quality, Groundwater Section,1636 Mali Service o: (COWr- II Vgh, NC N01
116Q9-1636 Phone N9!1733-3221, within 30 slays.

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and NaturalpResources - Division of Water Quality - Groundwater
CERTIFICATION ation{o3
WELL CONTRACTOR (INDIVIDUAL) NAME (print) �e?/t5!/,t/e'Iee(C t tip
,� YV�.�1 lP 1((t (lD PHONE 0(linS. 91C0
WELL CONTRACTOR COMPANY NAME //!/ 1lv' /
ASSOCIATED WQ FEruti117I
STATE WELL CONS [RUCTION PERMITB ASSOCIATED
icable)
if applicable)
(ifapp1. \VELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial ❑ Agricultural D
Monitoring 0 Recovery ❑ Ileat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest 'I own:
(Street Name, Numbers, Community, Subdivisidn, Lot No., Zip Code)
3. OWNER:
Address
City or Town Sate
(_--.)".—_------
Ares code- Phone number . /JC 6 `C
4. DATE DRILLED
5. TOTAL DEPTH:�M
County Cie,-J4e; e
26827'7
Topographic/Land setting
❑Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutesseconds)
Latitude/longitude source:❑GPS❑Topographic mop
(check box)
Mall nnN t ING I OG
From To Formation Description
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO 12-"--
7. STATIC WATER LEVEL Below Top oCasing:
5`6 Ff.
! (Use"+"I T
r AboveTop of Oiling)
8. TOP OF CASING IS , 7i Ff. Ahove Lurid Surface*
*Top of cuing Ierndnxted .tlor below land cu rGce requires a
variance In accordance with 1SA NCAC IC .0118.
9. YIELD (gpm)' r/�
5 METIIOD OF TEST /'
10. WATER ZONES (depth): r 9 6
/-� Amount �'-!T''r _
I I.a CISINFECTION: Type T Wall Thickness
12. CASING:
Depth ���'�e Diameter or 1, t'ghUFL M crial
Tom Ft. (" ,A5' — �—
From S:n1',1-I �'�,
From To Ft.
From_
13. GROUT:
From a
Front_
14. SCREEN:
Front_
From
15. SAND/GRAVEL PACK:
Depth
To Ft
To Ft..
Depth
To 0 Ft.
To Ft.
Depth
T�—
To_
From.
From
To
16J. REMARKS: —yam
I
1 DO HEREBY CERTIFY1r1144
CONSTRUCTION STAND
Ft
4ater
crtirit
Diameter
Ft.
Ft. in..
Method
— 7C
70.-7-'/U
Slot Size Material
_ in.
in.
Size Material
i nrn'rinN SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the roads
numbers and common road names. O o
co
L n
a
= cr,i
care
It
o ''
r-77N
0, 0
rn o
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
, AND THAT A$OPY OF TII18 RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGMA RE OF PERSON CONSTRUCTING THE WELL
Submit the original tortheDivision of Water Quality, Groundwater Section, 1636 Mall Service Ce nri REVg07 2001
11699-1636 Phone No. [phone], within 30 days.
DATE

268424
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division �offnWater Quality - Groundwater Section
�y
WELL CONTRACTOR (INDIVIDUAL) NAME (print) \S \U✓X dh� • ,-7 �t-�'I s ``.-) CERTIFICATION
#CEO f U
WELL CONTRACTOR COMPANY NAME 1V Yt `��\it Sat ' �' ""l ,"�' —"� PHONE # (T `2 �T l SC
ASSOCIATED WQ PERMIT#
(if applicable)
STATE WELL CONSTRUCTION PERMIT#
(if applicable)
1. WELL USE (Check Applicable Box): Residential l9" Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCA
NearessTrc'' i
t
(Street Numbers, Community, Subdivision, Lot No., Zip Code)
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH: t
6. DOES WELL REPLACE EXISTING WELL? YES ONO l!�
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
•
variance in accordance with ISA NCAC 2C .0118. 0.
9. YIELD (gpm): =1U MET QD OF TEST
10. WATER ZONES (depth): c
jfopographic/Land setting
mk'dge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Fomla('on Description
11. DISINFECTION: Type
12. CASING:
{h er
From U To ��� Ft. (o 4
From To Ft.
From To Ft.
13. GROUT:f� Depth Mat al
From_y)_ To SSD Ft.
From To Ft.
14. SCREEN: Depth Diameter Slot Size
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
DEPT
From TTo
0 rr
!M':g
Amount
Wall Thickness
C\ �R
Material
Size Material
From To Ft.
16. REMARKS:
MAtI -
LL
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road._?
numbers and common road names. o
^1
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE W
SIGNATURE OF PERSON CONSTRUCTING THE WELL
1 Submit 1ho.or:iginal-*RA1e Division of Water Quality, Groundwater Section, 1636 Mail Service Center -Raleigh, NC
4/301 opi'honb (0 ) 733-3221, within 30 days. GW-1 REV. 07/2001
A
r�:-
c

268427
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division
noof Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NA711E (pri t) `.)— VV LA CitM(•� �-�"�'�'� CERTIFICATION ita N
WELL. CONTRACTOR COMPANY NAME
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) —/ (if applicable)
1. WELL USE (Check Applicable Box): Residential IH Municipa)/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery ❑ Heat Pump Water Injection 0 Other 0 If Other, List Use
2. WELL LOC N.
Ne Town:
(S
3. 0
dies - 2L-
Street or
rypC�ity or Town
E��or>a
Area code- Phone number
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES
NO
V
7. STATIC WATER LEVEL Below Top of Casing:
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of cuing terminated at/or below land surface requires a
variance In accordan%a �with ISA NCAC 2C .0118.
9. YIELD (gpm): � L� MF{T1QD OF TEST
•
10. WATER ZONES (depth):
unty 1J.2>v7u �
nity, Subdivision, Lot No., Zip Code)
o.)
Zip Code
�JV \ ,E. v--`C�iK—; �� I•..k PHONE # ere) 5%9 sC
4 opographic/Land setting
Ridge ❑Slope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DRILLING LOG
Forma t ; Description
11. DISINFECTION: Type - Amount
12. CASING: Wall Thiclmess
1 er `°�,Weri,,.�t/Ft. �M�atprial
From b Deo 't"lP Ft. ft �' /• UU��
From To Ft.
From To Ft.
13. GROUT: Depth, tt II Mate al
From b To `t Rev Ft., t Q)4.
From To Ft. I
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and corm road names.
0
CO
J
75a)
COti1 TRUC'IION'pTA 4D
CAT
LI !co AR
LSubmit the original to
77649 18TA Miens No,
LLuTI3i
Aci E iL'L( h G '4l OIHCE
THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C, WELL
THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL 0'
_
SIGNATURE OF PERSON CONSTRUCTING THE WELL
o „ ision of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
) 733 3221, within 30 days. GW-1 REV. 07/2001

2. WELL L6CAT
N st Town: County
(Street N Numbers, Comm s , Lot No., Zip Code)
3. OWNER: • rela'L
Address ra _•7yti'.110n
No.) • It`s
State Zip Code
13. GROUT:
City o Town 5
CA)-
Area code- Phone number
4. DATE DRILLED
Subdivisi
D3
gin
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES lop
FT
7. STATIC WATER LEVEL Below Top of Casing:
(Use •'+•' if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C .0118.
9. YIELD (gpm): (3O METHOD F TEST °ail-
10. WATER ZONES (depth):
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
grWeight/Ft. ate`
Depth 1ameter
From D To Ft. L t{
From To Ft.
From To 1 ' Ft.
De `Ch F M tefial
cel�si...
From b To
From
14. SCREEN:
From
From_ To
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
„Li I DO HE CER't IF
1 ICONS IRUCTIONSTAl
To Ft.
Depth Diameter Slot Size Material
To Ft. in. in.
Ft. in. in.
268431
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division1of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME (print) M
0_)ai ( c re t..tca___ CERTIFICATION # l
WELL CONTRACTOR COMPANY NAMEWe �G k fit' -�����
U')" PHONE # ) -q 11 SS
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential El/ Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
Topo$$a�pphic/Land setting
❑Ridge ElSlope ❑Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH D' LLIN aG
From Ti) Fortnaft.n la tion
4, ater., - ,
s ..IL._-,
1
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.
0
\),\ ?,ccvk\
41IS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ry
AND THAT COP,Ar OF THIS RECORD HAS BEEN PROVIDED TO THE
I .,
j 119-2k ea_ Si °
pt—%SIGN ATURE OF PERSON CONSTRUCTING THE WELL
Wad -the orjgina! teAtr Divi, ion of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
Fl3f/6A9e1636P;tponeNo.:(?Hpk733-3221, within 30 days.
GW-1 REV. 07/2001
c

"fi81")
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resourcces - vision of Water Quality - Groundwater Section
CERTIFICATION tag
WELL CONTRACTOR (INDIVIDUAL) NAME p(print)
WELL CONTRACTOR COMPANY NAME t" " (t t`—E F'"t' u.-1 K1 PHONE #
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential C9 Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WE LOCAT aN:
Newn:
3. OWNER:
Address
t or Rout•.N`) `J \n
I Zip Code
Area code- Phone number \ 1 ��
4. DATE DRILLED
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES NO lJ
7. STATIC WATER LEVEL Below Top of Casing: i i7 FT.
(Use "+" if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surfaces
*Top of casing terminated at/or below land surface requires a
variance In accordance with ISA NCAC 2C .0I18. n `
9. YIELD (gpm): MET II OD Or TEST ""—'l-)
10. WATER ZONES (depth):
IS
11. DISINFECTION: Type At-14 4 Amount
12. CASING: Wall Thickness
eter o Wet t/Ft. a al
Depth am [, �t
From 0 To 40 Ft. 4t, ca9 -1.(0
From To Ft.
From To FL
Mat ;l
13. GROUT Depth
From To Ft.
14. SCREEN: Depth Diameter
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth
From To Ft.
From To Ft.
16. REMARKS:
Slot Size
Size Material
Topographic/Ian etting
❑Ridge ❑Slope alley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(check box)
DEPTH # ' LLING • G
From To Formati.n .lion
ey7A�tiy
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.
IEIMBY CER.110' TPA
I I O TRUCTIONSI sDA1
WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, LL
THATA C PY OF THIS RECORD HAS BEEN PROVIDED TO THE
ATURE OF PERSON CONSTRUCTINGL ^'
THEWELL D ,n /
Sukmit the original to the Divisio
2769®A036 PhbeeNo. l 10 %33-3221
ASHE,,.. _ uMOE
0
of Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
within 30 days. GW-1 REV. 07/2001

WELL CONSTRUCTION RECORD
North Cuolina - Dena; uncnl of Environment and Natural Resources - Division of Water Quality - Groundwater Seclion
\yELL COY! RAC I On (INDIVIDUAL) N\NIE (print) RA/VD if Cc)/ '/V-5 CFR7lFIG\'IIONp V34-
s I AI F W 111 COAST IRL'CI ION I'I RVIITf ASSOCIAI ED Ay(j ('rat.'Ill d
Of applicable) (if applicable)
„ELL Coy, It.AC!Olt (-OAIPANV NAIIIF,
2671.55
morn; M )7-3-7--`ISOC
1. WELL USE (Check Applicable Box): Residential Lt}' Municipal/Public ❑ Industrial ❑
Monitoring O Recovery O I Teat Pump \Valet Injection ❑ Other O Lf Other, List Use
2. WELL LOCATION:
Nearest Toren: /hkeO illy County 0/net:^ke,
1-1h&BCprs pia LOTS 1reAcr
(Street Name. Nmmbcls. Conmunlily. Subdivision. Lott No.., Zip Code)
1. ()WNl lt: To.41 /9/t/2) R.$cV1J Address aSifQ fJ/nw145<Pr� %,o-., �6iP>5 kb
I Sll eel or Route No.)
/11(,lr-�G »C -2-Sri()G
('its or 1 own Stale Zip Code
Arca code- Phone number
4. DATE DRILLED / -03
5. DOTAL DEPTH: .50 S
6. DOES WELL REPLACE EXIS-LINO WELL? YES 0 NO CV'4
n3o
7" ST A.1IC WATER LEVEL Below Top of Casing: Ff. ,23.3
(IJsc"t" if Above Top of Casing)
8. TOP OF CASING IS i PT. Above Land Surface'
'Tap of rasing terminated al/or Won laud sorrier requires a
'sari:utce In acrurAatice null, I5A NCAC 2C .II118.
9. 1'IEI.D(gpm): METHOD OFTEST/Q/k
I . AVATER ZONES (depth): /SO . ;230,, ,270
LOCATION SKIiTCI I
Show (lircclion and dislance in miles Ironl al Icasl
two Shale Roads or Courtly (toads. Include the road
numbers and common road 'miles.
I 1 . DISINFECTION: 'Type
12. CASING:
1)cplh Dialncicr
ProwTo_/JO Ft (54,
From To Ft.
From
13. GR0u1` Depth
How To 1I.
Pram I o
14. SCRLFN: Dcplh
1 tutu To
Rohl To
15. SAND/GRAVEL PACK:
IJcplh
Tu
To
1loin
From
Amount
Wall hoick nc.ss
or \\'ciilll/Il1. Nlalcrial
fvC_
nlalcri:d Method
Si,c
Ft.
Ft.
Slnl Siec hI iIcri:d
it).
in.
M; 1crial
16. REMARKS:
Agricultural O
/fopographlic/Land setting
'NCI{ ['Slope CI Valley Oflal
(check aptmgnialc boll
Latitude longitude of well location
(degrees/mimitcs/scuudsl
Latitude/loogitucic source:O(31'SO Topographic map
(check hot)
UEI'I-II DRILLING LOG
From To Formation Description
0 ro 2LI1) eta y
/c /.25 r✓A ZrTNFr'40 CF./-WI7G
/2.5 /so GRA/v/r4
45_o A 30
.233 Ss,Lo'tion, egy1ry
.5 e 5 G&4nu7 w 131-Aca;
CLArL ..s77224K5
// Ir
S :Z wd '1 1 war CO
IIj)(Y Fill1 ,1V l
I ITS WELL WAS CONSTRUCTED IN ACCORDANCE III 15A NCAC 2C, WELT.
AND 11IAI. A COPY OF'IIITS RECORD I IAS BEEN PROVIDED 10l TIE WELL. OWNER
Z:/1
. IC/NAT31121i OF PERSON CONS IRUCIINC, ll Ili \('ELT, DAII.
.M41M!t,lpf±:3ir. „'iS#ftTi{ONI Division of Willer Qualily, Gronn(hvalcr Seel ion, 1636 Mail Set ice Center- Raleigh, NC
ASSU lf/G`'(�G'r - 21,nTlhin 30 days. (iW-I REV. 1)7/2001

WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR ONDIVIDUAL) NAME (print) 1' 1)`C NU2_ 9 . \ t Ord 2 CERTIFICATION 9 al-5
WELL CONTRACTOR COMPANY NAME B YeRS Goat- D R t L( I N(6 .1- N C- PHONE w 'Vita 7y5--2/66
STATE WELL CONSTRUCTION PERMIT* ASSOCIATED WQ PERMIT'l
ifa y liable If licable
1. WELL USE (Check Applicable Box): Residential «MunicipaVPublie ❑ Industrial ° Agricultural ❑
Monitoring ° Recovery Q Heat Pump Water Injection ° Other Cl If Other, List Use
2. WELL LOCATION:
NearestTown:MaCC u YSUtt-t CountyCitERDKF_=
WOLF CoccSK COMM.
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: PRCST-0 Ni WESTMQ4a.Lam0
Address EY,x 22S PT. I. f^1-PVI2 ILL( YlNN•
(Street or Route No.)
City or Town State
(,87R- '1?9- pi-1
Area code. Phone number
4. DATE DRILLED I 'R - 03
37?Z17
Zip Code
.5. TOTAL DEPTH.
6. DOES WELL REPLACE EXISTING WFI r 7 YES O NO rifi-
7. STATIC WATER LEVEL Below Top of Casing: T
r (Use "+" If Above Top a casing)
S. TOP OF CASING IS 1. el PT Above' Lund Surface•
*Top of win terminated at/ur below land surface 'squire i
variance In acoordaato with ISA NCAC 2C.0111L.
9. YIELD (gpm): _ l F2 METHOD OF TEST 4I R
10. WATER ZONES (depth): e 2 5 - 3 77
11. DISINFECTION: Type f-i
12, CASING:
Depth Diana
Fro trl -milli_ To Re. Ft. (v /R
From______ To
From To
13. GROUT; Depth
From 0 To PC'
From To
14. SCREEN; Depth
r;wq
From To Ft.,jn.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
Ft.
Ft,
Amount -
Wall Thickness
or Weight/Ft. Material
SDR 21 PVC
Material
Ft CE''viC—�I�
Ft.
Method
�J22 v (Tv
D ameter Slot Size Material
in.
in.
16. REMARKS:
; 1 poloRlisie
C - N TRUOT
)N
267140
Topographic/Land setting
0Ridgs °Slope °Valley ❑Flat
(check appropriate box)
Latitude/longitude of well location
(degreeshninutesheeonds)
Latitude/longitude sotuce:OGPSOTopographic map
(eheek box)
DRTLLTNG LOG
Form! rion Description
TI5P Solt_
DEn Isf4 72,21•I cA?y
•Reotscl 2,u taap1de.ecp Roc.
f)2tk GRPv
L./atfrGRP y
12kErts or
RAW t 2 c
n)?PTI�
Froth To
o — ?
1,2 - ?Co
7la-/OS
)b- 3z-
�7�- -S?O
Pixie
rarck
I.IG *r Gas-/
GR9.Q1 Roci.c
LOCATION SKE•LCIH
Show direction and distance in miles from at least
two State Roads or County Roads. Include the road
numbers and common road names.
mAcce vs,/
G2.
1.1 µ,
tvet_t CP.EGK
Ca cis
�I 3•
?'�
�• DR rPON1
c
CO
to tz
r -
O
/fr I�+'✓J e F
1 /Zo�s
1 1 K 6e54T/bN
ve i C{v5Edc5 NC Sizzle (inc ivrro CheVocee Coun-iy, ejtD4-?e f NC-tOVA—Mu.IPAyN
"TFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THIE WELL OWNER
,-m , ____ /O — 03
1GNATURE 0P PERSON CONSTRUCt1NO THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section.,1636 Mail Service Center - Raleigh, NC
GROUND':NAIkFF` dOONPhoneNo.[phone],within30days. GW-1 REV. 07/2001
ASHEViL.LE REGIONAL OFFICE

267103
WELL CONSTRUCTION RECORD
Noilli Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section y
�77
tcI:I.1,(uNIRAC -I on(INDIVIDUAL) NAME Oulu() /\/IN,p V CO//iN i CF.ICIIFICAI'IONq�
lIONE
C NMI I'a (i7Y18S? gOc)S
vwr:Ll.cuxluAc'louco:vu'nNyNnn1E 1)e� �`'�-L� /
51 Al I: '\ El.I. CONS It('(' l ION 1'Elr11FIN ASSOCIA'f Ell \VQ HAW! I it
(11 applicable) (if applicable)
I. AVI'A]. USE (Check Applicable 13ox): Residential M- i Iunicipal/Public ❑ ludushial 0 Agricultural ❑
hlonitoring O Recovery ❑ I lcat Pump Water Injection ❑ Other ❑ If Ot her, List Use
2. AV[LL. LOCAL -ION: 1�/ �������
Nearest force: /1E4 r2_ I./ County
(11Bievissr3 /714/cr 2 t-r, i z Sjet t-tn;D UFO
(Sued Namc. Nombcrs, Cmninunily. SuhJivisiun, Lot No.. Zip Code)
���Topogral)hic/Land selling
Ir3lZidgc ❑Slope ❑valley ❑tial
(check approrl i:uc bnx)
Latitude/longitude of well location
3. OWNER: AL h' r `d aL/c T`5' (,tcgrccc'minnlukcconds)
Addmss _ it S LJ.>:fr. // S- I 64"/ Latit ulc/Inngitude source:❑GI'Sl7Topngraphic map
I S(check box)
u ccl or Route
% ) /cc_ .7r jcc Diii,nI DRILLING LOG
�. ilp l(am / „State zip Code Frool To Formation Descr iplion
(2Z)-r3 �- X 5—i 0 -� ,' ,� ('/4Y
Area code- Phone ml:nbc, 1 S / 5 IL) M -0i k'F_ 0 6 deAN're
4. DATF.DRIIJ.P.I) /-7-03 /6;i (-1/u/TC
5. 'LOTAJ_ DEI'I II: -5 YS /G,'7 55i5 CoR/,fNirk A-) 1ihtie / SLATE
6. DOES WELL REPLACE EXISTING WELL'? YES ❑ NO [ d- PiuAA'72- STRH/Ok.e5
7. STATIC WATER LEVEL Below Top of Casing: JOn FT.
(rise 4" if Above lisp of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
' •Tap of casing Iermin:nci al/ar below laud sat face rognires a
c:u:n¢e ill aaord:lov i flirt' 15A NCAC 2C .III I H.
9. YIELD (gpltl): $1 METHOD OF TlisTii/RC I iI %
IU. WATER ZONES (depth); /90 l i--
1I. DISINELCfION: Type Amount
12. CASING'. Wall thickness
Depth Diameter ar \Vcigbl/FI.
LOCA l I0N SKETCH
Show direction and distance in miles from al leas)
two State Roads or County !toads. Include the road
Material numbers and C01lllnn❑ road 11311105.
From (0 To /4, 7 I'1- C' `�' .$J)•(' 2/ I yC-._.
Prom 'It' Et.
From To Ft
13- CiRRO1.11': Depth Mulctinl Mclbod
El out 0 1oA:0 I'1. C-CWC'e! I Y'TL
Front "Q-O T o16^7 ft. c —im JS G ih', Tj7
14. SC.RIiNN: Depth Diameter lot Sizc Nlalclia
li
from to FI. in. in.
From --- 1 o, FIin. in.
15. SAND/GRAVEL PACK:
Depth Size M;dcrinl
I rout fo 11.
I1.
From
11)CL1.4L-AU,J+V'-H'-It�
CONS IRUCII I�h
// J•
O
CO
t_
,t+
O
W
!V
I IA I "IIIIS WELL WAS CONS IRUC I ED IN ACCORDANCE \VIII I I5A NCAC 2C. WELL.
ARDS, AND TI IAI. A COPY OF "I I IIS (RECORD HAS BEEN I'ItOVIDEU 101 I Ili WELL OWNER
cG^atto tl
SIGNATURIF OF PERSON (ONSI BUGLING 111E WELL UNIT.
c Division of Water Quality, Groundwater Section, 1636 plail Senice (enter - Raleigh, NC
733-3221, )within 31) Clays. (iW-I REV. 1)7/201)1

267102
WELL CONS'1'RUC'I'ION RLCORU
North Cal olina - Department or Environment and NaJt�ur�alyResoilurces - DivisionorWater Quality - Grouiidwalcr Section// 9L/
rYLil.((IVnl.rCI OR IINtI\'II)UAL) N NI1'. (prim) _L1GY.<1/(J7 C0//J��/ J ( CERTIEICAI ION a 2Jt7J
w..Ll.cuNlu\croucoamnN\ NAME C'ireuckec. L2el1 i/stilltt I'IIONE a pr".4737—K�8
S I .\l k: \V I:1.1. CONS.' RUC I ION 1'EIIPIT I t/ ASSOCIAI El) \\ Q I'Iiit11I ti (it applicable) (if applicable)
1. WELL USE (Check Applicable Box), Residential Municipal/Public 0 Industrial ❑ Agricultural ❑
Monitoring 0 Recovery 0 Ilea( Pump AVoter Injection ❑ Olhcr 0 I 1011ler. List Use
2. WELL LOCATION: (� Topographic/Land selling
Nrucst Town: Allot tui County et\$Jae Itrav ❑Ridge ❑Slope Malley 011al
flip eiLTS-M=w rii' r ., l-[) r 1 Sl9/'-A-mob be_ (check ::l,l,i„pnn:ieborl
(Sheol Name. N umbcis.Community. Subdivision, Lot No.. Zip Code) Latitude/longiludc of well localiml
3 OWNER: LL 42t,8 e-lP7'S
Address 6/ G CCi;-sue ti 5 f�u)r/
(Sheet or Roule No.)
,(
rig. or 1 oxen She lip Code
(iith:211- 37- itsJ 7
A lea code- I hone number
1. DATE DRILLED /-
5. "IOTA L. DEl l 11
_03
S
Idegrecshnin:nes/sccondt)
Laiimdc/longiludc source:OGI'SO-Topographic map
lcleck hos)
DI!I'TII DRILLING LOG
From TA,
Formation Description
0 £ Ci )/
S .5,5 --'I- j1R/)V4(
7C
G DOGS WELL 17I?1'I.AC1. EXISTING WELL? YLS ❑ NO
7 Sl A IIC WATER LGVEI, 13clow Top of rinsing: SQ
I llsc "*' if Abe lop of Casing)
8 FOP OF CASING IS _ I"f. Above Laud Surface`
op idcasing Icrtninale l aIt t- beta's land sur face requires a
variaucc In awl' n11L I5,\ NCAC 2C .0118. �L /� P
9. YIELD (gpni): r) ME11I01 OG TEST/4/h /%1"7
10. WATEIt ZONES (dcplh): 6 , «60
1I. DISINFECTION: Type CSu',Amount
I2. CASING: Nall Thickness
Depth Dian) r tx'Veighlll L Nlalcrial
'runt Q To 7✓? _ H. (- y - f ✓C
70111 To El.
'10111 To It.
Satz 2.
13. GROU"I` Depth Male'ial Method
Itch 0 Fo ;LI) H. (-'PCited T eV LILT'
f(1I4
Slot Size M;dci
n
iu
7ont To 1O Gl (' y_
11. SCltl`.LN: Depth Diantcicr
From__.
tom To fl. in
15. SAND/GItAA'Ii.l. PACK:
Depth Size
l0111 To I1.
I rttlli
NI it ter i;d
CONSI It UC I ION Sl
C
417E
N/7"L ti/ICrIi
E7 4� SLAT[
rke,a r, 5
LOCATION SKIiIY'll
Shovv dilcclion nud dislancc in miles hone al laid
Iwo Slate Roads or County Roads. Include Ole road
numbers and common road names.
0
273,
N
tie
0
c_.)
N
c
11115 WELL WAS CONS IRUCIT.D IN ACCORDANCE WIIII I5A NCAC 2C. WELT-
S, AND I ilj1F A COI'Y OF 11115 RECORD IIAS BEEN PROVIDED IDIIIL WELL OWNER
/ l p
/- O —U�Jy
SIGNATURE OF PERSON CONS117l1C I INC; 11Ili WELL DAIF
acF'A r)�iriiOVI),liulti;it1T,ky'I'IC hut-t)
ision of Water Quality, Groundwater Section, 1636 I\lail Service Center - Raleigh, NC
-3221, IN illiin 31) days. GW-I REV. 07/2001

267531
WELL CONSTRUCTION IZI3CORll
Not Carolina - Dernl nenl of Environment and Natural�jResources/- Division of Willer Quality - Groundwater Section
Wlilt.CON) RAC OR (INDIVIDUAL) NAME (print) "/�/',��1NI)V (O/Ii N_5 CERtlFlCATIIONa 21/34/
w E1. 1. CON' I RAC' I OR COMPANY NAME ( NERO i4E E ((Jett— ��.1_-�r'rnoNC a 11a3) 937-
SI.\l r: \\ 1.I.I. ('ONs RtiC'I ION I'hatdll'fa
lit applicable)
ASSOCIYI'Ell \V() PEI('l1 Ta
(if applicable)
WELL USE (Check Applicable Box): Residential fSl-Ivltlnicipal/Public ❑ Industrial 0 Agricultural 0
Monitoring 0 Recovery O Ilea) Pump Water Injection ❑ Other O If Other, List Use
) WELL LOCATION: I�
Nearest Town:
Counlyl /t leelect
(Street Mune, Numhfrs, Conmmnily, Subdivision, Lol No.. Zip Code)
'Iopograpliic/Lansiselling
❑Ridge OSlopc IP9alley Opal
tulucck appmprialc hat)
latitude/longitude of well location
3, OAVNi:R_ �� I Ke���' l t iC. �'�/�+'K-b� Idegrccciminmcs/sccnndsl
Address JTO /L_b FL.olue-Z. ^'� Lai ode/longitude so(Iree:OGPSO topographic nap
I. beet or Route No.) p C / (check bus 1
AI Lt ?JAL / I A) C 2.-6 /U` io DIil'TII DIULLINCI LOG
Lily or lust Slate Zip Cade Prom To Formation Description
(lk$)- ?:35 - 18 f 0 -5 SRNaY C/LgY^
Ana code- Phone nS Ls
umber -5 IJIM-r-/YMt.D A ,Q4N f 7..
4. DATE DRILLED j- 7,5 - 03 J3 3'5 &R4 4/7E
5, TOTAL DEPTH: /5 5 ,3S /$Jk/ _5 �tini r& a,. 3L,Tr6
6. DOES WELL REI'I.ACE EXISTING WELL? YES 0 NO @�
7. STA'I-ICWATERLEVELBclowTopofCasing: LC) FI.
(Use"r` if Above Top of Casing)
5. TOT' OF CASING IS I FT. Above Laud Surface'
'Tap of casing lermirnled at/or below land surface requires a
variance In accordance will% I5A NCAC 2C All It
9. YIELD ()rpm): /00 t METHOD OF TL•ST p/R /-/{7
ID. WATER ZONES (depth): /.20
11. DISINI'EC:(ION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weigbl/Fl Mulci al
From 0 To 3.5 Fl 4, %y 3DR-2/ PvC-
rt,
From To
From To
13. GROUT: Depth
(\laterialMethod
From r) To .zD Et. e ogeRS76 &RAv/TV
Penn a& t• 0 :3 s I I. �-s �CI i /15 n.AsI4✓LTy
14. SCREEN: Dcplh Mande' Slot Sic Rlalcri:A
From _ .lo Ft. ill. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Nlatclia!
fr(1111
From
To R.
t o Ft.
LOC'AIION SKEl -C'll
Show (Iircelio,' and dislance in miles from al least
lvvo Slate Roads or County (toads, Include Ills road
numbers and common road names.
0)
O
DONS TRUCIION S ANDA
ii : r
EB -4
IS WELL WAS CONSTRUCIIII) IN ACCORDANCE W1ll1 I 5A NCAC 2C. AVELI.
ND'1I I f A COJ'Y OF 11ITS RECORD I IAS MIEN PROVIDE') l0 T11LI WELL OWNER
nA
/ lS — 03
111
SI
INALURE ()II PERSON CONS RUC'I INC 111E \\'Elt.
DAII?
0
-y
0
S 'HIgt[OfLC'Rl. oivis
)n of N'aler Qualily, Groundwater Seclinii, 1636 Mail Service Center - Raleigh, NC
I, within 30 days. GW-I REV, 07/2001

267 530
WELL CONSTRUCTION RECORD
North Carolina - I)cp:utinenl or Environment and Natural Resources - Division of Water Quality - Groundwater Section
\FELL ('1IS111ACl OR (INDIVIDUAL) NAME tried) •r l aNV Y1 gC' C� �/: N 5 CERlIFICA1-ION
N 2yp3Y p
wEl.l. (O\Ili: \ C I D(( COnll'ANY N\nll': �LA'Q.11 bIZI I1 -?] PHONE # �_93' D00(J
SI,t'Ill tAT:LL (-OWNS -I (RUC I ION I'EItVIIlf/ ASSOCIA1 En WI) lEltMl' l$
Ill -applicable) (if applicable)
VVFLI, USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Ileat Pump Water Injection ❑ Other ❑ IF Other, List Usc
2 WELL LOCATION: /�
Neatest 1 own: ten u1�Ft-� County etLP lackce
CC•=('•etin Gib of )--ggftkiNIPS)
(Sliccl Nan,. Numbers. Community. Subdivision, Lot No.. Zip Codc)
Topogra hic/Land selling
012idge .lope ❑Valley OHM
check aepu 'rl:nc bnvl
Latitude/longitude of well localioll
3- OWNER: (?-Vn.Jy %),L(�%'i-� Ideprecshnimnles/second<I
Address / J /•1°16 0' K5 Re' Latitude/longitude source:❑GI'S❑Topographic map
(Street or Route No.) (check box)
IJ1L.I) Wccl L
Zip cede from To Formation Description
T4
taztirentecobKANirt
City or lrr.n Stole
(fi•ifl 2TS•—.5-7I Lf 0 /2
icetr)5 ( DEPTH DRILLING LOG
Arca cock- 4. DATE III l number
DRO 3
5. TOTAL DEI'III: 2 -5
G. DOES VVEIL(. REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: l Pb FT.
(Usc "a . if Above lop orCasing)
8. TOP OF CASING IS / FT. Above Land Surface'
, 'lbp ur easing Iermmalcd al/or bclolc land surface requires a
variance in accordance villa 15,\ NCAC 2C .III IR.
9. YIELD (gpnl):/CO -1- METHOD OF'riESi A)R 114 r
10. WATER ZONES (depth): 2/5 / 22 5
/2 A/5
2 yS t!iir, '✓
(Dv 1127 z
I I. DISINFECTION: Type Amount
12. CASING: \VallThickness
Depth Dia nctcr or AVcigllt/EI. Material
Front O Tots _Ft.6Ay S 2/ EYC
4rotll To I I.
From To FI.
13. GROUT: Depth Mate' iiI method
From i'` To 2O vC _ Ft. (o,2z S/ s&i v/7v
Itnnl C%LL Flo I I. CAA ri 5 6fi t4r,/
14. SCREEN: Depth Diameter Slut Size Meta tat/
from To I1. in. in_
IT0111 To FI. in. in.
15. SAND/GRAVEL PACK_
Depth Size Material
1-rom To IT
Frlllll to FL
16. RI(kIARKS:
LOCATION SKIilCII
Show (lircclion and distance in miles from al least
two Slate Roads or Cotu)ly Roads. hlcludc the road
numbers and common marl names.
0
0
(a
N
J
m
CA.1
O
uhnlil the original to Ih
Pflu l i ) 733-3
ASHEVILLE REGIONAL OFFICE
IIS WELL \VAS CONSI-RU('TED IN ACCORDAN(P. WI111 I5A NCAC 2C, WE.LI.
ND: IIAT A COPY OF 111IS RECORD I IAS UFFN I'ROVIDPD I O 71112 AVEI.I, OWNER
4
(;NAIURF OF PERSON CONS( RUCIING 1111
WIII. DATE
on of \Pater Quality, Groundwater Section, 1616 I\lail Service ('enter - Iialciglr, NC
21, within 31) days. (iW-I I2I/V. 1)7/21)1)1

267529
WELL CONSTRUCTION RECORD
North cmolina - Uepallmcul or Environment and Natural Resources1'- DivisionJof Water Qoalily - Groundwater Section
p
\\n:I.I. CON'IItACIOR (INDIVIDUAL) NAME ((prrl�ul) eR/1,IND Y 1..o )//I�.S / CERTIFICA IONp^7c�3
\\i:i.L CON 112.\ C 1Olt COMPANY NAJIE CH ERoKE� h3E.LL. ) I I LL_- i'X'' PHONE t/ (R2) 83J"DLIOO
SIA I1: \lil,l. CONSIIUICT ION I'EliUIli t! ASSOCLCI EI) \\Y) 1'ERUII p
(if appl icablc)
Or applicable)
I. WELL USE (Check Applicable Uox): Residential Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Kccovery ❑ I leat I'unip Water Injcclion ❑ Other ❑ II Other, List Use
2. AVEIL. LOCAIION: I'^
Nearest Town: �I u(->tiy County Cale P1)Y--�
»3eaCt-LV no b / AC R-€ S
(Slice! Naum. Numhcis. Community, Subdivision, Lot No, Zip Code)
3. OWNER: ('n)(Kt cy-- KI»1 TactCp,J
Address I/06, Htael,ncsScee 5T e-T
(Sheet or Rome No-)
/11un P1 t� I tiC �8 i
City or l ,WII Slate dd Zip Qnlc
IB"R)-� J..O
Area code- I'honc 'mother
d, DATE DRILLED 1 - I6 - b 3
5. TOTAL DEI'111: 2 yS
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ®�
7. STATIC WATER LEVEL Below Top of Casing: 5E 0 I:"1
(Use"r-" if Above lop of Caging)
8. TOP OI' CASINO IS 1 FT. Above Land Surface'
Topogra uc/Land setting
❑Ridge .lope ❑Valley ❑Flat
(check apprnp: Talc bus)
Latiludc/longiludc of well location
(lcgrccshninulcF/sccomis)
Latiludc/longiludc sourcc:❑GI'S❑Topograpllic neap
(check boll
DIi1'll) DRILLINGI,OG
From To Formation Lion Description
3o 4.2 nyeRe-D SL'gTer
3o o 3Luk SL4-r c_
6o C a-- aLvb .SL.'qT
rap or casing Ierminaled :War helm. land surface ru;Wres a
v:nk,r,cc In accur,Iannc nilh I5A NCAC 1C .II118.
9. YIIi1.D(gpm): /,Q ME IIIODOF'FESI. R L/PT
10. WATEI& ZONES (depth): l0
I. DISINIECI
2. CASING:
Rom Q
From
From
3, GROUI•
_
From (7
ION: "fypcf HLOt/A/4Amount 2- erns
Wall Thickness
Depth Diamcicr or \vcighl/Ft. Material
To_7ofl. (o y .ssR2/ PVC
To it.
LOCATION SKI: ICI I
Show dircclion and distance in miles Bunt al Icasi
Iwo Slate Itomis or County Roads. Include the road
numbers and c(1I)Il1ml road Ionics,
ro 1'(.
Depth Mnlcrial hlclhod
To 20 D. eo,veR.676 6RAVtTy
I Ran PO? "l (1 tit' II. (iv;
I4. SCREEN: Ucplh Diameter
I lout__ ,)
Fm I:1. in
ro.fo FI.in
15. SAND/GRAVEL PACK
Depth Size
Fr ont To I:I.
horn I (1 1'I.
lot Sizc Material
16. RFNIARKS
S WELL WAS CONS 1RIJ('lYD IN ACCORDANCE WIIII I5A NCAC 2C, 1WEL1.
1FIE y;1• A COPY OF 1111S RECORD I IAS MIEN PROVIDED lD 11III WELL OWNER
0
0
fV
J
0
NATUItI:(NI PERSON CONS I ItUC1INC 111E WEI.I.
J-/6-0:
DAIL
it of \Paler Quality, Grouud\\nter Section, 1636 hlai1 Service Ceuler - Raleigh, NC
1, within 30 days. OW -I ItEV, 07/2001

U L
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Reso - Division of Water Quality - Groundwater Section
W
WELL CONTRACTOR WIVIDUAL) NAME (print) r RaN7I CTen R CERTIFICATION * 317 5
�
WELL CONTRACTOR COMPANY NAME 13 `t9C7Z S 0...1 EL L D i'Z 1(-L- (I V (s' ryy
PHONE ity'-ter 72IS-Z/6,
STATE WELL CONSTRUCTION PERMT # ASSOCIATED WQ PERMIT!i
if liable (if applicable
269073
1. WELL USE (Check Applicable Box): Residential I' MunlcipatPublic 0 Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery 0 Heat Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Nk RP►HY' CouatyCfk-ROkEt
Ha((Ke Dee -
(sow Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Neat fc eiHaWr
Address 7C Ke:-PLiatt Mt DR
1 U Z a (Street or Rout: No.)
(L NY i4C a8906
City or Towo Stu/ Zip Code
SDI- R27-5R8?_S
Area code. Phone number,
4. DATE DRILLED ,� -/3 03
5. TOTAL DEPTH: (n 2 S
6. DOES WELL REPLACE EXISTING WELL? YES U NC)
7. STATIC WATER LEVEL Below Top of Casing; 7S FT
t (Vie "+" If Above Top of Grim
S. TOP OF CASING IS I IL FT Above Land Surface'
'Top of colon terminated hour below land surface requireu ;
9. YIELD (gym): METHOD OF TEST S / R
variants In accords c will, 1SANCAC 2C .011S.:
10. WATERZONES(depth): /2S'
11. DISINFECTION: Type tf1 t14 Amount - I Yt lb
12. CASING: Wall Thickness
Depth DiarRettr or Wsight/Ft. Material
From 75 To 70 _ Ft, (r 7k / 8Fl STheL
Fro'1 m6 To /O Ft. 6'AFC _CYIIR�l PVC
From /C To ( Ft (n%Y SORr?4 PVC
13. GROUT: Depth Material thod
From r2& To C3 Ft. Coil ccUY- GfV( ''
From To Ft.
14. SCREEN; Depth Diameter Slot Size , Material
From To Ft.____ in. in.
From_ To Ft.40_,.Jn in
15. SAND/GRAVEL PACK:
Depth Size Material
From To
Ft.
From To Ft.
7o 94
a /(o . Soo
073c' Soo
Soo S90
S$ ' 25
Topob1c/Land setting
QRidge OSlope ❑Valley ❑Flat
(chock approprisb box)
Latitude/longitude of well location
r(d mirninutes/ecamds)
Ia_timd ✓1^_ngir de soUrce:QGPSCTopcFapI v ,a -up
(checkbox)
DARLING LOG
Formation Description
-row ,soa_ � taco'
hear..,,/ rfav
GPO,/ ea get-'c
sev6 GRaAI/r
94- Lt614r6Pev
'O2Rk Gte2Y -S c. c• "La
// -GRA1- "cock
&2RK G4sr Q«-h
2C .€k 6Cdch�. cK
DEPTK
From To
LOCATION SKETCII
$how direction and distance in miles from at lust
two State Roads or County Roads, Include the road
numbers and common road names. x
t
N
I„Nral/JG
Do b r2D
/331 4
,teodeatr T
MTTI OR ,
WR ribi
rn
JOE
iforis
/ 4 E (tl u R rot4 V
NIL
16. REMARK$:
a: z:nu,FY THAT THIS WELT, WAS CONSTRUCTED IN ACCORDANCE W1TH 1 SA NCAC 2C, WELL
�CONST k CT IO STAT ARDS, AND THATI PY OF THIS RECORD HAS SEEN PROVIDED TO nrr WELL OWNER
I1� U
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Moil Service Center - Raleigh, NC
27699-1636 Phone No. O19) 733-3221, within 30 days, GW.1 REV. 07/2001

L
WELL CONSTRUCTION RECORD 2 7 014 9
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (XNDIVIDUAL) NAME (print) rtzvvz. P. V I L%tR CERTIFICATION 3 / 7.$
WELL CONTRACTOR COMPANY NAME YC-12S W (-LC_ DILILLI 1,14 PHONE #706 745:?/6{o
STATE WELL CONSTRUCTION PERMRM ASSOCIATED WQ PERMTrt
ifapvlicable)lif aPPlicable
1. WELL USE (Check Applicable Box): Residential L'fMunicipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery E Heat Pump Water Injection 0 Other ❑ If Other, List Use
2. WELL LOCATION:
Nearest Town: Pit U R PI-1 t% County&--E
/33/A t.l ie l t4G DOG 2cL,
(Street Name, Numbers, Community, Subdivision, Lot No., Zip Code)
3. OWNER: Minx DeLL-
Address.5Gti f1iCwi47e—i?
(Street or Route No)
jfbtVQPAS' 1,)C o2gY10 2
City or Town State Zip Code
e2&)- 2 7— Ryas
Area code. Phone number
4. DATE DRILLED o2'I�-'03
5. TOTAL DEPTH, as C
6. DOES WELL REPLACE EXISTING WELL? YES 0 NOV
7. STATIC WATER LEVEL Below Top of Casing: 2 FT
,r (Use "+" If Above Top of Casing)
8. TOP OF CASING IS e24 PT Above Land Surface'
flop of cuing terminated eke below land surfue requires a
variance In accordance with 1SA NCAC 2C.0118.
9. YIELD (gpm): 81/-7 METHOD OF TEST rnt //C.
10. WATER ZONES (depth): 7 S
11. DISINFECTION: Type /1-7-µ Amount /t- Ln
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Front/03 To 43 Ft a LSIIQ LI Pvr
From a_. To 0 Et. 6 r Sb ,b pvc
From To Ft.
13. GROUT: Depth Material
From. To a Ft. (r-fe.N'i
From To Ft.
14. SCREEN: Depth Diameter Slot Sim Material
From. To Ftin in.
From_ To in,
15. SAND/GRAVEL PACK:
Depth Size Material
To Ft.
To Et. _
Method
aPiairrV
From
From
16. REMARKS:
Topo c/Land setting
QRidge Lope ❑Valley ❑Flat
i (check appropriate box)
Latitude/longitude of well location
(degtecslminutes/eecoads)
Latitude/longitude souree:OGPSOTopographic map
(check box)
DEPTH f PTL,L,ING r Oct
From To Formation Description
0 i 'MP S..ect-
), 3 $oor"1J ctav
3 / l� c-l.B
/8 ,so t L ctt-t 2:ie
So 65 yG-fca,
larellt46-0
fp Ras' wEzraiiier, Roa"c
L/GAIT $ 74S0 /?^.
02P& & tc-daCQ/hoe to
LOCATION SKETCH uv�� `-
Show direction and distance in milesp rgm apeast
two State Roads or County Roads, Include Eie road
numbers and common road names.
e,
/34/5
t t214/
h&c.
I DO HEREBY CERTIFY THAT THIS WELL W
CONSTRUCTIOIg,STANDARDS, THAT
MAR SFbgdt2 rigt2 27699-1636 Pbont o (
S CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C, WELL
COPY OF THIS RECORD HAS SEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF
ON CONSTRUCTING THE WELL DATE
03
the Division of Water Quality, Groundwater Section,,1636 Mali Service Center - Raleigh, NC
19) 733-3221, within 30 days. GW-1 REV. 07/2001

269350
WELL CONSTRUCTION RECORD
North C;uolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section`/
WFi.L n coNtAcr(nt (INDIVIDUAL) rvnnlF (print) RA/V.0Y re, //L ys CERTIFICATION /12y3Y
WELT. CON I ItACI OR COMPANY NAME
S I Al l: VEl.l, CONSTRUCTION l'ERMITP ASSOC LU WQ
(if applicable) (if applicable)
( t key toc, II DR; I t&9 PHONE If (EC*1��7•
I. WELL USE (Check Applicable liox): Residential E Municipal/Public ❑ Industrial 0 Agricultural 0
Moniloring 0 Recovery 0 I -Teal Pump Water Injection 0 Olhei 0 If 0thcr, List Use
WELL LOCATION: /� I I
Nearest Town:�''1C ' County Olte� ke
f11_k 4sst s mi L 4CQ9-SS Ro4.D
(Socel Name. Numbers, Community. Subdivision. Lot No.. Zip Code)
3 OWNER: 471-71A) C bdPoi Fbe_b
1•L ho X /OZ7
Address
nl
(
kSircel or R��o991c No.) oG tiah v 1 i IX' I
City or 'l 1' State Zip Code
IrNTJ)- fll 7
Arca code- Phone number
4. DATE DRILLED 3- 6 - 03
5. TOTAL DEPTI I: «95
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: _J.O FI'.
(wen- if Above lop of Casing)
8. T01' OF CASING IS / FT. Above band Surface"
•Top of casing lerndnated al/or below laud surface requires a
variance in accordance %slit I SA NCAC 2C .0118.
9. YIELD (gpin): ion t METIIOD OF TEST T R LIP 7-
1 . WATER ZONES (depth): '9 5
I I. DISINFECTION: Type Amnon(
12. CASING: Walllhickncss
Depth Diameter or Weight/H. Mlalcriai
From 0 To /2.5 EL 6 r Sl)R.2/ A✓P
Rom To Ft.
front "ro Ft.
13. (iROUF: Ucplhp
Ft oniJ� To Fo 1.
Prom Tn Fl.
Malcrial Method
CONCR42k a BRIT l r
Id. SCREEN: Depth Diameter
From Fe Ft.
IYom_ "Fo Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
Flom To F1.
,'Fopograpllie/Land setting
&Ridge ❑Slope OValIcy ❑flai
(cheek appropriate bon)
Laliludc/Iongiludc or well location
(degrees/minutes/seconds)
Latitude/longitude sourcc:0(7PSOTopographic map
(check hos)
DRILLING LOG
Formation Description
SAD Clay
RAN/7"
ARA,vg7rb,
I)l I'l1
from To
•iQ.—
jpo 50
Z90 YR—S
Slut Sizc Malcrial
Prom To 1'I.
16. ItFNIAItKS:
LOCATION SKETCH
I
Show direction and dislance in miles from at (cast
Iwo Stale Roads or County Roads. Include the road
numbers and common road MIMICS.
C..1�0 �4�iIt��UV\;'1'G I�IP
f trONSTRUCIIONSf N
"-S,elCniii Ilic 1mi-0111014o the
Ac . 276199-1636 Phone NtG$919)
T THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wllll I5A NCAC 2C, WELL
DS, AND THAT /j.5.'OI'Y OF 'EATS I2'CORD 1IAS BEEN PROVIDED I0IIIL WELL OWNER
i
SIGNATURE OF I
3-6 -o3
)N CONS I RUC I MCI "Il IF WELL DA 1 E
)icisinn of \\'alcr Quality, Groundwater Section, I636 Mail Service ("(, Wrl REV. Raleigh, NC
O01
33-3221, within 31) days.

269349
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section Y�1,
ELL CON I ItAC I OR (INDIVIDUAL.) NAME (print) RM DY C6 /71 ij 5 / CER7I FICA!IONN ( y
CONY RACt OR COMPANY NAnIE C'-JEPto KEL.. WG� DRII-L(N6-pDONE a {'?M p37—CN/?
S I'Al E \\ 11.1. CONSTRUCT" ION PEltalrrf ASSOCIA'IEl) \VC) 1•E1 111ff
Of applicable) (if applicable)
1. WELL USE (Check Applicable Box): Residential Municipal/Public ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Recovery ❑ Ilcal Pump Water Injection 0 Other ❑ If 011lcr, List Use
2. WELL LOCAT I ON:
Nearest Town:7
/ )1 a ✓Z �y
D
opographic/Lana selling
County eiepcket. trifel-gc ❑Slope ❑Valley ❑Flat
(check approprinle box)
(Street Nmnc. Numbers, Community,
,SSubdivision,
pLot No., Zip Code)
Latitude/longitude of well location
3. OWNER:ii L Jc 4eLb4( tit
Address `I) 55 /Cl2ND )9V-6
(Su eel nr Route No.) 33778.
(' I own SC,Iee Zip Code
( 7)"ity or 77� - o9OG�
Arco rode- Phone number -o
4. DATE DRILLED Ts-.5
5. TOTAL DEPTH: Q /
6. DOES WELL REPLACE EXISTING WELL'? YES ❑ NO [kT.
7. STATIC WATT?R LEVEL Uclow Top of Casing: 73 P'T.
(Use "4-" if Above Top or Casing)
8. TOP OF CASING IS / ET. Above Land Surface"
• tit of casing (et initiated al/or beton laud surface requires a
carlauce hr atencrda ce with I5A NCVC 2(' .1I118
.
9. \'IELD(eptn): f 2 ME"fIIODOF TESL'}/RAitT
10. WATER ZONES (depth): .2/S
(degrees/minutes/seconds )
Latitude/longitude sourcc:0(31'S❑Topographic map
Icbcck box)
DRILLING LOG
Formation Description
S AVicon W
/ S P S tJ o22r6RLlJ /nR1N/T6
,23 3o S j3WA /', R44? _71
-u- 2L 4eX J LATE
SE�I/rl s
DISI' I
F rellr fo
/5
11. DISINFECTION: Type C/YLOR/A/S
12. CASING:
Depth Diamcler
From_ O 1R),3 6_ Ft. 6 24,
From To Ft.
From fo I(.
13. GROUT: Depth Almeria'
From D To 36_ Ft. syT
from To Ft.
14. SCREEN: Depth Diameter Slut Size
From To l'i. in. in
in. in
Ainotm(2 CUPS
Wall Thickness
or \Weight/Fl. Material
5pg,2L Pve.—
From "To Ft.
15. SAND/GRAVEL PACK:
Dcpllr
Prom To 11
1 tom To PI.
16. 12E111ARKS
Method
GRAv77Y
Sac Material
Matcrinl
LOCATION SKL'TCII
Show direction and distance in miles from al leas(
two State Roads or County (toads. Include the to.
numbers and common road names.
0
CIN
.1) L1 Ole II'1 "flr
I. �TC1STR(1C. (ION ST? '4DA
L
1T1111S WELL WAS CONSTRUCTED IN ACCORDANCE Whit 15A NCAC 2C. WELL
DS, A J 1IIAT A COPY OP PIS (RECORD 11AS I31aIiN PROVIDED.'0111L• WELL OWNER
o ',Submit the original to the
ASI'[`:'2`7G'!'1-1636 Phone Niiii919)
SIGNA OF PERSON CONS" RUCTING illE WELL DATE
)'vision o Water Quality, Groundwater Section, 1636 Mail Service Center - Raleigh, NC
33-3221, within 30 days. GW-I REV. 07/2001

269847
WELL CONSTRUCTION RECORD
North Carolina - Icparnnent of Environment and Natural Resources-�Divi�siioan of Water Quality - Groundwater Section
\\111.I.CCIN'IIt.\ Cl Olt (INDIVIDUAL) NAME ( ,rin2)_ (1 D//V L;p'(q,�/yS CERAIEIC�/T�ION a ,25C3�'
\\ f.t.l, CU:N"I ItACTOlt CUMPAN\' NAME ` /WIRDk.EC toe I I 1111'DJ I'IIONE 0 (FDA ?37—SOo3
STA7 E \\ I:LI, CU,\Sll2UCl ION I'EI2:\I I'IW ASSOCIA I Eli \\'Q PEItdlllll
o rapplicable) — (if applicable)
I. WELL USE (Check Applicable Box): Residential Ira'/ Municipal/Public ❑ Industrial 0 Auicullural ❑
Monitoring ❑ Recovery ❑ I Ica( Pump Water Injection ❑ Other ❑ If Other, List Use
2. WELL LOCATION: 1 L
Nen rest 'fo\vm �{ IS cm., [Qp
I Street Name, Numbcis, Cnminunily, Subdivision, Lot No.. Zip Cole)
3 OWNER:
Address
/535 NE DAK1—IC1-1 4 d-
rusc�l�(Snec. Rauil t �9S 1
City i (Mil Stine
Zip Code
— 3 77
Area rode- Phone number
4. DATE DRILLED .2-12`03
5. TOTAL DEPTH: 70_5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO !Er-
7 STATIC WATER LEVEL Below Top of Casing: _j c 3 rr.
(Use •'F" if Above -fop of Casing)
3. TOP OF CASING IS 1 IT. Above Land Surface'
-lop of rasing terminated al/nr below- land surface requires a
variance in accortIq nn�ee ss lib I5A NCAC 1C .011A.
9. YIELD (ppm): 16 METHOD OF TEST AI4 ,U27
10. WATER ZONES (depth): /65
I I. DISINFECTION: Type CilhORi/YL- Amount 3 C0P5
12. CASING: Wall Thickness
Depth Diameter or Weight/Pt. Malcrial
From 0 le39 Fi. h- ' ..S.DA'2/ PvC
From
From
13. (3ROUT:
From O
Ft.
To PI
Depth Malcrial Method
To -SO it COMCR6,76
�RAY2-ry
from To I:1.
Id. Sr. It EEN: I)cplh Diameter Slot Sizc Malcrial
Rout To I - in ill- _
from To I . in. in.
15. SAND/GICAVLiL. PACK:
Depth Sizc Malcrial
from To It
From To FI.
16. Ri. NIARKS:
r 7-
1 II Ib IIPjRLl3\ S;GR I`' ' IIIA
CONS IIRUC HON SFAN I.f
"Topographic/Land setting
Ridge ❑Slope ❑Valley ❑flat
(check appropriate host
Latitude/longitude or \veil location
(degrees/mi m ncs/seconds)
1 aliludc/longitude source:❑Ct'S❑ Topographic neap
(check hos)
DRILLING LOG
To Pormalion Dcsc riplion
8 F'j2 J.
$ /S 4j64ryc/Z2 Sl.Ar6
LS 3D SS t & S .LA T4
r
DLI'11I
I'rnlll
O
2O
5,S
7on� &RAiYi-r6
LOCATION SKETCH
Show direction and distance in miles from al least
Iwo Stale Roads or County Roads. Include the roar.
numbers and common road names. o
w
O
0-
11IIS WELL WAS CONSTRUCTED IN ACCORDANCE \PETIT 1 5A NCAC 2C. WELL
S. AND ITIAT A C�I111S RECORD IIAS BEEN PROVIDED TO TIIE WELL OWNER
/ t
.2 -/,2 0 3
ri
n
0
z
iNA CURB OF PERSON CONS RUC I1NG HIE WEI.l,
DATE
Submit the original tit the U risinn of Walcr Quality, Groundwater Section, 1636 Mail Scrrice Center- Raleigh, NC
27h99-+6MrPhnnt-No.fNlt}71,-.1221,nitltin311days. GVV-I REV. 07/2001

269846,
WELL CONSTRUCTION RECORD
Notlh ('al olina - Dep;rr[mew of Environment and Natural Resources - Division of Water Quality - Groundwater Section
\\'El.I. CON I I RAC I Olt (INDIVIDUAL) NAME (Orbit) Rfl MD Y Co / /i_M5 GE_MIF-ICATIONN a' V
2 sy3' S'
\\EI.1. CON ill.\(' I On COMPANY NAME \ .v�o 14e I1. Ri I t uoi PIIONE is MA) & 7--UQO8
SI Al r: \v lil.i. CO,Nsrrt(Cr ION PERMIT'S ASSOCIA I E.l) \\9 I'EIINII IN
lirapplicableI (if applicable)
I. WELL USE (Check Applicable Ilox): Residential ta---Municipal/Public ❑ Industrial ❑ Agricultural ❑
MonilorMg ❑ Recovery ❑ llcal I'uulp Water Injection ❑ Other O 11'O111er, List Usc
2 WELL LOCATION: ^
Nearest Town: /)•t r,t/l \/ County Pi) )(QC
1-1t> Yo P-b
I Siam Name. Numbcls. Conan may, Subdivision, Lol No.. Zip Code)
3. OWNER: -DA 4 as
Address 5 1(^) l/rou1K5 Ru
(Shed or Roul No_)
_A/4PLaS IC L
City nr'l awn 5/I11lc
1D3`1 5"9 y - n 530
Alen code- Phone number
4. DATE DRILLED
5. 'IOTAI. DEPTH: % 9,5
6. DOES WELL REPLACE EXISTING WELL? YES El NO [Lk- rs O
7. STATIC WATER LEVEL Below Top of Casing: 7.5 FT.
(Ise "4- if Above Top of Casing)
8. T 01' OF CASING IS 1 FT. Above Land Surface'
Zip Cotic
Midge
setting
I'3ltidge ❑Slope ❑Valley ❑flat
lebeck :q,propriaic bout
Latiludc/longitudc of well location
Idcgrecs.hni m,lesiseconds)
Latiludc/longitude source: ❑(il'SOTopographic map
(cbcck hied
DRILLING LOG
Formation Description
DEI'IIl
n 0111 To
•lop of rasing Iermlunled at/or below laud surface requires a
variwlce In accordance will' ISA NCAC 2C.0I IR.
9. YIELD(gpm): /SD METIIODOPTEST jel/12 2./77-
ID.
WAI'L_R ZONES (depth): /f o,, 6591121
I I. DISINFECTION: Type C.y.COR/Nl Armond 3 Cop3
12. CASING: - Wall Thickness
periling?, Dianycicr or \VciulilA t. M;dcrial
FronlD To O n. G Y SDR1/ pv�
From To PI.
from To E1.
13 (;ROUT: Ucplh Material Method
limn 0 To4 O
fionl To fl.
14. SCREEN: Depth
O S
,5 6 S
/ fio
SSo
69S
RED SANDY cLAV
4Lign/e.R4I1 3Row)v SL474
,03L1 b -SL4T4
&R4))1174c w- 324T4,
r' N, T
LOCATION SKETCII
Show dircclim] and distance in miles From al least
Iwo Stale Roads or County Roads. Include the road
numbers and common road names.
ft. CZ-Mb/v7 C,l€4 vITY
Diameter Slat Sizc Material
Tram_.._ Ta Ft. in. in.
From To 14. in. in.
15. SANI)/(;RAVEL PACK:
Ocplh Sizc Material
Pt 0111 TO Pt_
1'1-(111 Ta Ft.
16. R ENI ARKS:
I do 1 IliltEOY CElli I1EY
CONS RUC LION S IAN!
7-
0
0
IIIIS WELL WAS CONSTRIJC"I IiI) IN ACCORDANCE WIl11 15A NCAC' 2C, WELL
AND I11AT A COI'Y� W TIUS RECORD I IAS I3EEN I'ROVIDE,D TO 111E WELL OWNER
-2 `/9-0 3
RE 01. PERSON CONSTRUCTING 111E WELL UA t E
Submit the to fhe Di 'ision of Wader Quality, Groundwater Section, 1636 Mail Service Culler - Raleigh, NC
27699-1636 Mimic No. (9h9) 731 1221, \villein 30 da1s. O W-I REV. 1)7/2001
rn_
2J
rrl 0
0

WELL CONSTRUCTION RECORD
Nolth Carolina - Ucpa!intent of Environment and Natural Resources - Division of Water Quality - Groundwater Section
1�r
T.l a. COST WWI Olt (INn1Y1O(IAL) NANIE (p�rint) R4 y
MD i t0 l/,�J\/S CEIrrIFICAlTON a gf r UE1.1. CON 111 \ C IT 11t COMPANY NAM,. P 1206 t L1€ .L_i2 iI ( (P3J mow:. a(3)23) %37-'O(-03
S'I AIII W 1:1.1. CONS RUC ION I'Eltall'I'N ASSOCIA'I-F.n \\'Q III:10111P
lit applicable) (if applicable)
I. W 111,1. USE (Check Applicable Eos): Residential EW Ntunicipal/('optic ❑ Industrial 0 Agricultural 0
Monitoring ❑ Recovery ❑ !lent Pump Water Injection 0 Other 0 1f Other, List Use
2. WELL LOCATION:
Nearest Town': ,a9 r.�%Z��. County(-
I�Ut11���)L�/' —r )-QT 3I
(Street Name. Numbers, Con✓'laaily, Subdivision, Lot No.. Zip Code)
3. OV.'NIiR:
Address
icon 7)70EGACHE/AI
9c ' H4I13rk.
Steel or Route No.)
4./1P F.L_ .3_%O
C iy or I own SiAte Zip Code
(7,24- .56:0 — 6 o! _
Arcs code- ('Lone number
4. DATE URILLED.225/-o3
5. 'TOTAL DEPTH: 70.S___
6. DONS WELL REPLACE EXISTING WELL? YES 0 NO 11//
7. STAIICWATER LEVEL Below Top ofCasing: SO FI.
(Use"' if Above Top of Casing)
'DTI'8. OI' OF CASING IS / FT. Above Land Surface*
'Top II( esiiup lerndnalvd al/or below land surface requires a
variance In accordance with I5A NCAC 2C .01 I8.
9. YIELDL METHOD OFTEST)i/R ,LftT
10. WATER ZONES (depth): 5 )Q/
LOCATION SKETCII
Show dircclion and dislance in miles from al least
Iwo Stale Roads or County Roads. Include (road
numbers and common road names.
Topo��g.r�a /!tie/Land selling
❑Ridge L451ope ❑Volley OHM
(check apprnpriale host
Latitude/longitude of \vcll location
(degrees/minutes/seconds)
Lalinulc/longitude source0G1'SO Topographic map
Icbeck hex)
DL'I'TI' DRILLING LOG
From To Formation Description
0 /n .j S4N17Y CZq)
/0 (QS . RowN `(- TAN .s,gN,05roM6
8 3 .2/o G RAN( 7-4
42Lh 70 5 ,3Lge/- .5)-4-T4
I I. DISINFECTION: Type Cy.Co Lii
12. CASING:
!kink
From 0 To / Ft
From) To Ft
From To Ft
13. GROUT: Depth
From_p "fo.ZQ
!Tom To Pt.
Amount � t.uA5
Wall Thickness
Diameter or Weight/H. Material
smf a/ pve
Material Method
(L CEME/YT R212T?__
I.I. SC11EI1N: Depth Diameter
Mom To FI. in
From To ft. in
15. SAND/GRAV111.I'A(LK:
Depth
Flom To
from To FI.
16. RENIARKS:
Slot Sizc Material
ua.
in.
Sizc Material
It
9-111 1tl l)' CER 1 n Y ru�l
� )NSI_ROC UQN__S I ANPAI?4
1
WELL WAS CONS IRIJC TEI) IN ACCORDANCE WI III I5A NCAC 2C. WFI.L-
lI IAT A COPY OF I I IIS RECORD I IAS BEEN PROVIDED TO'II IE WELL OWNER
URN OF PERSON CONS IRUCIING II II' WELL DATE
Submit I he original lull a 'Arising of NYaler Qualily, Groundwater Section, 1636 Mail Servire Corder - Raleigh, NC
27699-16361'Imne No. [phone]� within 3(1 (la)s. GW-I REV. 07/2(101

WELL CONSTRUCTION RECORD 2 6 9'715
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (INDIVIDUAL) NAME'(print) FRP, 7 P. Kt C773R CERTIFICATION u3/75
�"
WELL CONTRACTOR COMPANY NAME Y6RS t,.-I Cei—L. DatLLIrt(o Tt'cc. PHONE #coo 745-Z/66
STATE WELL CONSTRUCTION PERMITS ASSOCIATED WQ PERMIT#
ifa licablo If licable
1. WELL USE (Check Applicable Box): Residential le-Municipal/Public 0 industrial 0 Agriculuual ❑
Monitoring 0 Recovery Q Heat Pump Water Injection C] Other 0 If Other, List Use
2. WELL LOCATION:
Nearest Town: MUfRP41. County C(kk-ROKS�
}1PNC,Itl� Doe
(Suter Namc, Numbers, Community, Subdivision, Lot No., Zip Code)
3, OWNER: A.LV l N riUD
Address a la (ACT _L NE R.D VIAORDIIY, NC.
I u R PAy (Strom c Route Na.) a890(0
ry or Towo State Zip Code
($ V7 -7242
Area code- Phone number
4. DATE DRILLED 2 —2 Fs— 0
5. TOTAL DEPTH. ? 2 5
6. DOES WELL REPLACE EXISTINGWFI.T? YES es...NO ❑
7. STATIC WATER LEVEL Below Top of Casing: -.7)Q i,
el (UPC "+" if Above Top of Casin)
8. TOP OF CASING IS PT Above Land Surface'
*Top of tunny terminated .true below land statue requires t
variance In accords],ce with 15A NCAC 2C .01184 .
9. YIELD (gpm): (O METHOD OF TEST a L R
10. WATER. ZONES (depth): 75
11. DISINFECTION: Type
12. CASING:
Depth
From 2. To 5"7
FronS7 To37
Fromji7 ,To 2-A
L•{TF{ Amount I/2 b
13. GROUT: Depth
From O To e
From To
14. SCREEN: Depth
From, _ To
From To_
15. SAND/GRAVEL PACK:
Depth
From_ To
From To
Wall Thickness
Diameter or Weight/Ft. Material
Ft. (a ml k • 1ST STEG-t.
Ft (o'/ t s.R 7/ Pvc
Ft (p'/a ,i-o&fir Pvc
Material Method
Ft. Ccrvtc-wio CR61/4t1-1-7
Ft.
Diameter Slot Size • Material
in.
Ft. an, in. -
Size
Ft.
Ft.
Material
Topographic/Lalldletting
DRidge ❑Slope 15Valley DFlat
(check appropriate hoz)
Latitude(longitdde of well location
(degteet/minutes/accoads)
Latitndeiloatgitude source:OGPSuTopographic map
(check box)
D_EPTFL PR1'I.LINGLOG
From To FormationDescription
0 - I TdP So/I.
/ - 33 yc-cco a) ct a'I
31 - 57 13126w4 luparg&2eD Ore f<
.S7 - l R S WI RY Rasc-K
l BS — 215 </Gfar c✓lafRe/c-te
LOCATION SKETCH
Show direction and distance in miles from at least
two State Roads or County Roads, Include the road
numbers and common road names {. } o
'Joc'
cp
16. REMARKS:
CONSTRUCTION
Submit the origlhal to
27699-1636 Pbone No. (
a
-R.2 M,.,
(tiro
zro l3Rowu y yo
T-
THAT THIS WELL WAS CONSTRUCTED TN ACCORDANCE WITH ISA NCAC 2C, WELL
ARDS, AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED ID TIm WELL OWNER
SIGNATURE OF I RSON CONSTRUCTING THE WELL DATE O3
be Division of Water Quality, Groundwater Section,1636 Mall Service Center - Raleigh, NC
9) 733-3221, within 30 days. GW-1 REV. 07/2001

WELL CUN5'1.1tU'ION iu ! ill:II
L r1IONE II I(
C r,�•
f 1s(){1 y()�
No11h Carolina - Department of Environment rind Natural Resources - Division of Water Quality - Oroun o.ares .peon n
NI ELL CON 7 RAC1olt(INDIVIDUAL) NAME (WM) SCF,RIIF ICAl1ON 7
(1 Tj�,----2`I
—
11�r l
rvELL CON I IIACI Olt COPIFANS' NAME� t
ql
A55OCIA"I P.It wOrP.RMI7M �—
5tAIEtVELLCONS r11UCflUNfEMIIDI ---- i(oirl icnblc
if a , ,licnblc
I. WELL USE (Check Applicable Dux): Residential 117/tvluticipal/I'ulrlic U Industrial U Agricultural 0
Monitoring 0 Recovery U Ilea( Pun, Water Injection 0 Other U If Other, List Use
TopogrnphidLmld setting
URidgc LISlope 11Valley float
(check npprnpd Ile hoe)
Latiluddlotlgitude of well location
N_ 3 S o6 _gtel ..5
( Jepreetiminulestrennd,)
Latitude/longitude source0 PSfU 1 opograpIic m=p
ILL±LUI ))RILLWOLOO
hornhorn1b yin tion Description
2. WELL LOCATION: County
cnres I otvt''
(Siner thole, Numhen, Conununlly, Suubddiiivielon, Lo1 tlo., Zlp Code)
J. O\VNER: 1, It
Address s orb- 1:11L PC
(snrel orRnule No.)
Slnre --- Zlr Code
City or 1 n
Arrr code- (bone number
1. I7nfI 1)1111 LI'rD`' r
5. TOFALDEP1lL___ ----
6. DOES WELL REPLACE EXISVINO WELL/ YES L1 U
7. STATIC \VATEIl LEVEL Uclot(tierpeoIf A Abng:ove Top of Conlin)
A. TOT' OFCASINO IS �___—
1-f. Above Land Surfncee
f
•inp nr•dne In ndndrd .Inns below lend 'mine mild' el
•
vinfante In Burt Jain! r,llh 15 MGAC IC f I1OD CIE E51'rn�n
9, YIELD (gl'ul)
IU. WATER ZONES (depth):
,,.r 1' •TA, Amount._¢
II. C S IN L•CTION:'1}'Ite Walllhickuvo
12. CASING: Depth Diameter er Weight/I'I. Male, inn
'1-n_. i'r.
from Mai u I Mctho_
ri
IJ. CiROUh: Depth
fn rt.
�
I-v__-tit ._ _ __ Material
now__ Diameter Slot Sire
Id. SCREEN: how F.,Depio. in. _
I. 1'I _
Float_ __- Rr_
15. SAND/C0RAVEt PACK:Depth Size Material
I.n 1(
ROW
Flom io ft.
6 REMARKS
1
ir501 L12 CfRIIFYl1IAT11
ICONS -RUCIION SfAPIDNU)S,
270297
Show direction and distance in miles from al least
two Slane Roads or County Rands, Include the road
6••,e nor' rnnunnn to dd names.
0
cJ
0 0
LI• WAS CONS I1ll1CI1'D IN ACCORDANCE, W1111 15A NCAC 2C, WELL
IA T A C01'Y Of 1111S RECORD 11AS DEEN PROVIDED 10111E WELL OWNER
SIC NA URE OF PERSON CONSTRUCT INU 111E WELL DATE
} unlit Croundtsnler Section, 1636 M2II Service Ct" er1 1lEVaU2 N001
Submit the ho to No.l to 19) 331721I vision o Ithlt 30 Water ()minty,
ays. Yr
116ao-I6J6 Phone (919)7JJ-J211;

270292
-YELL CUNSTItUCTWN lUsl;ORL:
11 iIli CnIulina - Deli:101 lcnl of lalvItunalent end Datum' It soutees - Division f 1Duality - Uroundvatter Sedwl
CER I IFICAItort 0
mom!fOZ1R -z
\cF.LL cUN IRACI tin 11Nnlr'Int?Al,)NAp1E 11,rinq
1%F.L1. CON IItACIUn CUnlrAr1Y NAME ASSVCIAI Ell INpF.Rp11IN
StoIF, \v Fit CONS IIInC1IUN fEIln11U --- iIn,rlicnb lc
if n diaMc
U
ltufal
I. \1'GLI, USE (Check Applicable lllt
leat: Residentialet IRJcct Injection frnUlherlU IfUlhrcr, List Use
nglicl__---
ilotiu CI Itccovesy U I
Hon g
2. WELLLI?CATIUN: CuuutyCn"
U r:nest. I otcntn h�-
Ie1� ICf---> __2g Iv. Snlnli virlon, I it IIA.r 71p Q.Ir)
re Unpnq tlnmhrn• i:,.�......,n
1. OWNER!.—
Add'css OtA`-"`'".�---
I I,rtt o, Ronle Nn.)
C1k1 Sln 7.11, Code
Chjily pi I ,
le
Ncn (NI/. Muse nu,bet
. d" NA1 EUItILLl.N
5 t!I_irALDl:111f. S2--------
ft. DURS WEI.I. REri:AU ENV; u!U W!'I 1 4 -YES U Nll lid'
7. SEAIIC\VATIIlLEVEL Below U°I'oRAhnveio��fcnnl„n) I°I.
1p DE CASINO IS - _..-" _ __ pl-. Above I.ntd Sulfncc'
g. • Irr rl tni"I In mh,.ryd Wet Lila" Iund ,mbcr rrgnar, •
,r,lrnrr In attritI1' "Ini I5A 111iIC IC 111!IIsI L�--
IU. \VA hill ZONES Itlrpthy _
r.—nmowd _ ?D
II. I)ISINEECI-ION:1-) Wntllldcknrss
12. CASINO: llrptll Uinarctcr of WdphU I binlclinl
Dom to---- 19._— — - — .__
now_ l i, Ft. - Method
1-1 pad linl
13. 1-1oti . t I'1. n ��/ %-
1l am__ I n o��-- i rr < u�ts-
I'ntn___ Uinuletcl Slot Sire 14. SCREEN: Ncpll, In.
1. EL —ill. ---
Flom — il, _ _ •ill.
Dow__ _.l0----11.
15. SANItltiIlAVC1.I'AU:: pinlulnl
1)rplll Sire
-I I' -
Eo
hole
Lon,
I' 1.
IDO111'nrul•CEItl M'111A111
CONSIUu l0t1S•IA!IIJAIu)S;'
Topuglnph{dl,told netting
Ullidgn I]Slape I ]Volley Ul lnl
Icl,erk npplop, lnle !nit)
Latitude/longitude of well location
asio4uia_c_ti56;s5
tdrpreeJudm,IrJtaroil,)
Lnlian'. arl^neiludc stnucc:lIf 14'SL1f- apogtnpllic 111 91
(ceck
))L' 11 NLU).LILJ LS).0
hula Ib ) pnnalion Pescliplion
In i��l
IL�D I�
---- I(ll� SKIiJI;i1
L�cn1.
Sllo\v ditcclloo rind distance lit mile!! Galt nl knsl
Iwo Slate Rends of Could)/ Mandl. Include the land
‘.Rumbcts and cotUllatl land Ranres.
MISSoy', Rd.
(JI
'Ell, WAS CUNSI IIIICI III) 111 ACCUIIUAIICI? WI 111 15A IICAC 2C, WCLt.
IIIAEACUP? urns RECORD tinsLIVEN 19tOVIULUiU1III WELL OWNER
:IUlll! UI` I'UtSUN CUPIS11tUCIINU'111L WLILL DAM
{n}�p{ I IVntrr O mIIly, Clnmld,rnleF Section, 1616 Mull selvlce Cenitr{ IILIVRU1 2UUl
NC
"CterO11 Ott n them
N . (919)Ihe 1±i1-3111, within 311 dnys.
176gq-If th l'hnnc No• 1 19)
�>II

270274
WELL CONSTRUCTION RECORD
'
North Carolina - Department of Environment and Natural Resources - Division
f Water Quality - GERu dwattr Sz ctioll
IDL) NAtint ,N, Z9�,'1
WELL CONTRACTOR(INUIEAN NAME IE (P ss ) mune M VT )Z31----
W'ELL CONiMC10R COa1ANY NAPF, ASSOCIATED WO i'ERMITM
(i(nR ilicable)
STATE WELL CONSTRUCTION EEnmirt
(if appl ienblc) _.
I. M
t. nphi rnblc Box): Residential IA—Munieinnl/public 1J Industrial El Agricultural El
Monnitit USE (Cheek
El Recovery
..,overy O Ilcal fungi Water Injection L Other L7 If Other, List Use Topogr,q;luc/Lund selling
IyRiilgc I]Slope ❑Vnliey QFlnt
(check appropriate boa)
Lal!lUddlongitude of well location
I1/3S;b9WIS5
2. WELL LOCATION: Countyil2
Nearest1ownt'U �--�--� r. n rrwl.
City or Torrn Stale
Arra code- phone nnmbt `2 _3 _„�
4. DATE DRILLED 4
5. TOTAL DEP Li 1:___6--- d 1 NO
6. DOES WELL REPLACE EXISTING WELL7 YES --- --
7. STATIC WATER LEVEL Dclo,(Top UIf AboCnsvegTop of Casing)
8. TOP OF CASINO IS (
—
El. Above Emil Surrnce'
'Top art rating ter nlnt l lu IS boon Wui .011$. requites •
variants In accordance with ISA NCAC IC.011l. -_
METHOD OF TESTAL--_
2
9. YIELD (gPor)' —�---- � !ON KE G�
I0. WATER ZONES (depth): L41_L1�-l—.
��► Amount K Show direction and distance in miles if OM al least
Type . �• Iwo Slade Roads or County Roads. Include the road .yam
11. DISINFECTION:"rye Wnll1hlckncss
12. CASINO: 'Thunder or WcigliUPL Material !lumbers and conuno, names. Depth DC -Z kt C
Front—�i--To \fl, ) t. /., a5 5 Z 1 1JC LE___
rt. __
F From =a
From, Tn 1't. Method
nlnt tin!v
IJ. GROUT: Depth / o
From! — To Et. �ra1t —
PL---- e\d PaJ�ree
hnnn—D° Material -
Dimnelc, Slot Sim _
14. SCREEN: InDein. in.
From ! {1—r
I'l. in. in. COut
From To
IS. SANUlGRAVDeptEL PACK:
Depth Size Mnlcrinl '��'n ,
From To Ft..
Frem To PI.
I DO IIEREBY CEli.
11AOSiEv ,rt5
L
pc
(Street Nan . Numbers, Community, Subdivision, Lot No., hip Code)
0 , (degrees/ndnutex/sxenels)
3. OWNERs5 Latitude/longitude source:LIGPSC1Topograpllic mnp
(check boa)
Addlci� cif �LL�Q L0G
P
From To �orrr�ali�l�rscriplion
hip Code
I lAT 11115 WELL WAS CONSTRUCTED IN ACCORDANCE W I1lI I SA NCAC 2C, WELL
ARDS, AND TIIAT A COPY OF TIIIS RECORD IIAS BEEN PROVIDED TO TIME WELL OWNER
SIGNATURE OF I'ERSUN CONSTRUCTING THE WELL
DATE
1 G'd
;ICE
lNC
u m I the urlglnnl Io the Uh•IlIoR of 1Valer Quality, Groundwater Section, 1636 nisi: Service Cenle� - Ilalelgh, ..
21699-I636 Piwnc No. [phone], within 30 tiny!. Uµti REV. 1
p

WELL CONSTRUC'1'!ON 1U LORD
North Carolina - Department of Ellvirouulcut end Natural Resources - Division of Writer Quality - CER11clion
a1/GL7
1Y ELL CON I MCI OR (INDIVIDUAL) NAME IPrI"1)PHO
LIONI� ►�L9�f�
writ, CON1RAC1OR CONIPANY NAME IYI \ EJ' ASSOCIM P,11 w'r]PEMII IN _—E 1
1FICA
5IA1E wELL CONS r110CtION(TIN( f� if o(dicablc
if n ? dicnblc
I. WELL USE (Check Applicable Dos)! Residential (vMuuicipal/Public U Iudushiel El Agricultural U
Monitoring U Recovery U I lent Pump \Vnter Injection U Other U If Other, List Use
folloglnphic/Lnnd selling
2. NcnLst.1oni'fTOIN�,:('1D1l1 CuultY�_ 2L^Itps Ultidge 0SIope UVnllcy ❑Plat
Ncalcsl l Vw11:1l � �� -- (check npprrgnlnle Inn)
UP ��—c E —"--- — Latitude/longitude of well location
Jumben, CT.�oo.""bv, SnhJivielon, Lnl Ho:, 7.Ip Cork)
(Cel I : t -
(drp'eeJnJnv4yrq-cnnih)
1
J. OWNER: � Lnlilude!!^n¢iludc sourcc:VOPSUTopogrnhhie nzgr
Adtllcss wit—� (check M+)
(Sneed or [Thule Ile) Mill
uRILLING LOti
��sQ ^n st�\~ I Ponnnl'o° I)csuipfiun
City m lorvn Slnie
Zip Code 0 ' l 5 e(
Ncol r. number
,i. PATE DRII 11113_0—
6i-e)3 7 _
5. IDEAL 110'ri 1:_s_ - .rrr1U0 \V I:l I 1'/ YES Li NO u
6. DORS WELL REPLACE E^I._" - al E E.
7. STAI IC WA FEE LEVEL I1cIo�t0T°I'4°If Aboof ve ion nt C•610
A. 1 In DE CASINO IS _,�. —
IT. Above Lend Sul Bice'
'lbp rl rotor In initiated drrr hrlon land nn rate rtqulrn
, •r in, ce In n cor dance whir I5A NCAC IC .ally.
0, 1'IPI.P In Mli fllOU OF 11)51�
Ill. WA1E1t ZONES (depth): __---LIKIVI IuILSY.17c;11
-------- Show direction and Jistnnee In miles Gom tit Iensl
r-' Amount L Iwo Stele Reeds or County Rands. Include the road
II. UISINf1iCPION:llI \Vnl\Vni Weight/Ft.
12. CASINO: Uimncler or WcighVrh hlnlcrinl uur(j1t>±Is end conuuan load names
Ilrpll' � r 'J"'`t
pion. (� l'oL Et.J.Ct — 2,/ ,1
rwm 71• Io _It.4 _Ls.'.0 .S..eet— '1�
now_ I °- I I Method Y;
Depth Mnlcn I -
11. OROUI: I r Pt ,�a1 '
�tL:cnes
P(om TO__ El Mnluinl C ' ry
SCR!' Uinnlcicr Slot Size J Tnz
14. FIPIIIrN Ucpl11 in. > `� _
T„ 1'L_iu.
floor in. ce-
{.
flora_ 6
15. SAND/GRAVEL PACK' o
Depth Size Material ^
yes . ut
h° I°I. tr. —
form :-Inr
troll( To PI. -- en, Ge
G e
c;
270272
36. REMA1L\K,S:
I
I DO HEREBY CERTq
,Q11SI,RUCUOMSTr`�
C
T 11IIS WEI.1, WAS CONS IltlICI EO IN ACCORDANCE WI III 15A IICAC 2C, WELL
DS, AND TIIAT A COl'Y 0P 11IIS RECORD IIAS BEEN PROVIDED 10111E WELL OWNER
-/9-0
SIGNATURE UP PERSON CONSIIWCIINO111E WELL DA'I E
_ [fj!n ti ttl6 oFYRInn r o le )Icltlnn of \Voter Qunllfyr Crnundlvnler Section, 1636 Mall Service Curler, � REV. L_°07 2001
210Q-1616 Phone No. [phone], within 311 days.

270442
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural
^Resources
/- Division of Water Quality - Groundwater Section
\VEI.L ('ONI ItACIOIt (INDIVIDUAL) NAME (print) /7/p/��l `�"��/�N-S CEIt1 IFICATlON H..cc7
sy
VVE1.1. CONTI(\COIL CONIPAN V NAME Ckcr,5 cC- �(Je l f My�+, PHONE M f )
ST Al f: \\ i:I.I. CONSI'RUC IION I'ERN11 r# ASSOCI .1 f:O \VQ PIiRDlfrp
I it applicable) (if applicable)
I. 1VELI. USE (Check Applicable Box): Residential IV'Municipal/Public ❑ Industrial ❑ Agricultural ❑
Monitoring ❑ Recovery ❑ Ilea; Pump Water Injection ❑ Other 0 11 Olhcr, list Usc
2- WELL LOCATION:
Nearest Town: /4-14K94,/ _ County (/l474dK`3c
CpE',v6'r12- DS L,k t /24 rife t tW )r<7ekttA N,t-t_ t6C t7
IShcci Name. Nmabers. Community. Subdivision, Lot No.. Zip Code)
3. O\1'NER:ewY; R,al.Cr1%. P.,/yy/v-C. 4. v,.4.
Address ulea ,E'.i)G�7 L.!l.✓•=�
(Street or Route No.)
st Any
pry oJr bss,( Slate Zip Code
(Pr y37—, o '7
Area code- Phone number
4. DATE DRILLED 2 %Z3-3
5. TOTAL DEPTH: 6_‘) .5
6. DOES WELL REPLACE EXISTING WELL? YESO NO El7. STATIC WATER LEVEL Below Top of Casing: 5 F'r.
(Usc "+" if Above Top of Casing)
8. TOP OF CASING IS / FT. Above Land Surface*
-rip of casing terminated otlor below land surface requires a
variance la uccordauce with 15A NCAC 2C .0118.
9. YIELD(gpm): .Z.J M'TIIO OF ST/4//RL /f7
10. WATER ZONES (depth): 2 / J/
�� Topographic/Land setting
B31Zidge ❑Slope ❑Valley ❑Plat
(check appropriate box)
Latitude/longitude of well location
(degrees/
1. atitude/longitude sour
11. DISINFECTION: Type Amount
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material
Ilom D To j/f Et.& %y SDk.2/ PvC
From To Fl.
From To Ft.
13. GROUT: Depth Material Method
from 0 To 20 Pt. 4_Mi.,S ' GAtivi7y
From To Ft.
14. SCREEN: Depth Diameter Slot Sizc Material
Front to I I. in. its.
Flom To h1. in. in. _
15. SAND/(TRAVEL PACK:
Sizc Mate 11
Depth
lions To
Front To
Ft.
t.
16, I, iJ'tams h r
:7 L S
i /iI UlJ IIldtEl31 LT_IZTIVIT
1' CQNSTRUC LION SJ,ANDA
i I r .^I -' Li
DEPfH
From re-
2°o e
85 //Y
anS
minutes/seconds)
cc:❑GPS❑Topograph is map
(check Kw)
DRILLING LOG
Formation Description
RED SHIv.71`l CLMY
& -R D wN SLg7d
<vZ ,,SLgr7-
LOCATION SKETCII
Show direction and tlisiancc in mites from al least
two Slate Roads or County Roads. Include the road
numbers and common road names. _
ITS WELL WAS CONSTRUCTED IN ACCORDANCE WHIZ 15A NCAC 2C. WELL
ND j'1NT A COPY OF TJ.ijS R i_CORD I IAS BEEN PROVIDED TO T I IE WELL OWNER
.2-.23-03
GNATUI ' 'EItSON CONSTRUCTING T lili WELL DATE
P`VrnlLi)htdhe urfritn Illt)ii*fi0C Uivi:ion of Water Quality, Groundwater Section, I636 Mail Scnia' Center - Raleigh, NC
27699 1(36 Plume No. [phone], within 31) days. G W I REV. 07/2001

270698
�<-/{ 7!—
LOCATION SKETCH
Show direction and distance ill miles lion al (cast
Iwo Stale 'roads or County Roads. Include the roar)
numbers and common road mnes.
WELL CONSTRUCTION RECORD
Nord) Cnrolin2 - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
RAND
r7 n CEICIIEIC\IION H-2-934/
\\ I:LI. COST It,\C 101t (INDIVIDUAL) NAAIPn(I^-/tllt) Rr w.lJ // �r`'n�/Z /1/ 5 ��7�, §
\ J\eRO�, /uell b.RIII(r�� rIlONEH a���Z�`OC.�r'
51,\l r. \\t:t.I. CONS] RUC110N i'EIU\li IN ASSOCIAI En \VQ VEI001111
Brapplicable) (if applicable)
\\ ELL CON -IIt.\C-FOR COATI AN\' NAAIE
I. AVEL1. USE (Check Applicable I3ox): Residential lIZIunicipal/Public ❑ Industrial O Agricultural O
Moniloring ❑ Recovery ❑ Ilea( Pump Water Injection ❑ Other ❑ 11 Other, List Usc
WELL LOCATION:
Nearest Town: S 1 e co /: f-i County 0ileRc:leE
-Q(A2Ctz 51ecc)/4-H 1213 HoP—$e
(Sbcct Name. Numbcns. Community. Subdivision. Lot No.. Zip Code)
3 OWNER: JCL °i'— ChARLL,JP PoL wall
Address j'33 SP.JYe.JIP L Pi ct
(Sheet or Rout No.)
/1?AatoJ-n (.;-,4 700E7
City or Posen Stub Zip Code
(Thz)- S 6 4 --'1 g c'
Al ea code- Phone number
4. DATE DRILLED / ` /3 ` ( 3
5. TOTAL DEPTH: )2 O 5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: iZ �l 1T. c9Ca
Topographic/Land setting
❑Ridge OSlopc f iIlcy OHM
(check appropriate host
Latitude/longitude of well location
Idc grecs/nninutesicecon ts) O L.)Latitude/longitude sourcc:OCi I'S❑lopograptr reap;--
(check box)
DRILLING LOT;formation Dcscrll ion- --=
('nB1?1L S
DEI'TII
From To
z0
Rise --C. if Ahnvc Top of Casing)
8. TOT' OF CASINO IS 1 ET. Above Land Surfaces
'Tap of casing Ice mingled at/or ltclosv laud surface mph es
ques a
rariaacC in acct,rd:nnre sill' I5A NCAC 2C .111 I R.
9. YIELD (gpn�S i): -MEOF-110D OTEST ,2112 ,L/L,L
IP. WATER ZONES (depth): 90/ /60
11. DISINFECT ION: Type 1'N.ICR/A/L Amount 2(1,,,V o$
12. CASING: all Thickness
DepthDial)lctcr or Weight/Id. Material
I roe •. s 0 To ' ( I t. n
:to ii O To RD rt. 5 `1/'
a
front
13- (IROU'I:
=tom n
».5
tV 7"
SJL LC
2n 3 g
3R 5S
ti- eakime -r
LDSo
To PI.
Depth Material Method
To.2c Ft. eC/VC&L7L— 6(04-v/J-Y
'eoni_ 3s2_ To 2(2 fl-_Cu ir voy S CytA✓IT
14. SCREEN: Depth Diameter Tot Size Mancha
from To IT in. in.
Tom To It. in. in.
15. SAND/GRAVIi.I. PACK:
Depth Size Material
ont
'ton)
To Ft.
To fl.
16 RIhInKKS—
i�
1 T`(3 !wiz (Tilt I LP1
CONS IRUC, )N STANI
Snhrinit the a'u gt,�T.lfhe D
-04i34- r(rt11'1'tfrf is
TIPS WELL WAS CONS IRIJC IED IN ACCOIMANCE III I ISA NCAC 2C, WELL
S, AN,O MAT A COPY 01 11115 RECORD I IAS LBIEIIN PROVIDED TO 1 Dl'. \YELL OWNER
W
O
J
SIGNAIURIi OF PERSON CONS IR000NG Tl Ili VWELT.
DATE
vision of Water Quality, Groundwater Section, 1636 Mail Service Colder- Raleigh, NC
-3221, within 30 days. GW-I 'REV. 07/2001
4J.1/
n__

2"
WELL CONSTRUCTION RECORD
with colon na - Ucpm tnicnt of Environment and Natural
l 'Resources - Division of Water Quality - Groundwater Section
"WELL CON" ItAC' OR (INDIVIDUAL) NAME (print) R4 ND V O-+_}Zi' LS CEItiIFIC�AIION t1 24C-TY
VE1.1. CONK RAC(' Olt COiNI1'AN V NAME ��.'1 1/Tti'i IAil I• IIONE a)uA$Jr7- r(S
S I AI r: r\'ELLCONS -IItupION PERM ITN ASSOCIA'I' En MI) Pt..fJ(dll' IN
(if applicable) (if applicable)
271066
I. WELL USE (Check Applicable I3ox): Residential Municipal/Public ❑ Indust'ial ❑ Agricultural O
1310161ot ing ❑ Recovery ❑ Ilcat Pump Water Injection ❑ Other ❑ Ifother. List Usc
WELL LOCATION: Topogrn lien and setting
.m
Nearest Town: uck
Counlynefi0K ❑Ridge , lope OValley OI hd
SPA?. Cd- o l-eF MT n1ofT1-e,/R)✓eRRD (check apprivialcburl
(Slut Name. Nmnhcus. Community, Subdivision. Lot No_ Zip Cock) Latitude/longitude of well location
3. OWNER: 7T/AViD Aiyz-
Addiess i() /r1AD t5v.f1 DR._
Illrccl or Route No-) c
uRp V NC ot27 8 7 olio DI'PTII
City or IUa) � Zip Code El utll -fn
5 `37 7�3G ._5
1_ )
Arco code- ('hone number
4. DATEDItILLED .2-1.3-0.
5. TOT(. DEPTII: 3Q.5
5 3S
G DOES WELT. REPLACE EXISTING WELL? YES CINO 19 9
7. SIATIC WATER LEVELL3clowTopofCasing: 7 VI.
(Use "+" if Above "Iop of Casing)
8. TOP OFCASING IS I FT. Above Lind Surface'
•Tap of cashrg terminated al/or below laud surface wilily es a
ariance In actor (lance Pith ISA NCAC 2C .0118.
9. YIELD (gpnt): �c.7 METIIOD OF TESL- .1IR Litz
10. WATER ZONES (deplb): 1151 /50
11. DISINFECTION: Type CHZok/Nh
12. CASING:
Dialpcicr
l. G v _ Ana 2/
Fr.
Pt.
Depth
Fro)) O To 90
fron) To
from To
I3. GROUTDepth
from 0 TnZ -
nom D.(:)To
I SCRl[EN: Depth
Rom To Ft. in1-tom 0
15. SAND/GRAVILI.I'AC'K:
Ucplh Sil,c
I'Inm T(1 El.
fron To Ft.
Amount .2 Cups
wail" hickness
or Weight/Et.
Material
,oyC
Material Method
O It.Co/WA E7E �`/'�' R4ii rY
) FL CZ+ri'.,95 0- 4Vlj
Diameter slot Sin Material
in.
in.
Material
I do grccs'n,inule s/secuosl
L ilituddlongiludc soul II'SO TopngrII)Ilic map
(chest(hns)
DRILLING LOG
Formal ion Description
SANDY RI.71 ZAY /)
RID S t9MD5TA o'C
3s 90 S��rG
0 3!0.5 fi,u& SL4y
LOCATION SKETCH
Shoal direction and dislance in miles from al Ieasl
two Slide (toads or County Roads. Include the road
numbers and common toad names.
0
/VDTTLE
t-i
r J@K Rb
16.REMARKS:
ire
41 �
L
o_RE,;��EitII
mNpiitoici ICi)N OAA
APR 1 0 2003
L Submit Ilie or iglu:110 the
rt. 27(199 16361'Innit ,Il.�919)
CO
1 TIIIS WEL1. WAS CONSTRUCTED IN ACCORDANCE AViTI1 I5A NCAC 2C, WELL n
DS, ANI1)111AT A COPY OF)3IIS 12 iCORD I IAS BEEN PROVIDED I O111E WELL OWNER-
/ 7 -7CD
/J 0JC)
SIGNATU1Fti f PERSON CONS RUC [INC Il Ili WELL.
DA"Ili —
Division of Water Qualify, Groundwater Section, 1636 Mail Senicc Center - Raleigh, NC
33-3221, within 31) days. OW-1 REV. 07/2001

"'71.123
WELL CONSTRUCTION RECORD
Quality Groundwater Secliuu
LC�"
North Carolina - Department of Environment and Natutal R 9outccc DiC� Con of Water y CERTIFICATION i
(print) ASS
WELL CONTRACT OR (INMPAN NAME NAME (I') //'' In 101) 1 Irl�� 1�1 PHONE I CY-2.
w'ELLCUN1MCt On COMPANY NAMF, r/ / ASSOCIATED 1vt)PF.RMIFN
STATE WELL CONSTRUCTION fEM1f1� if o , dicablc
if o r rlicnblc
2
W
Residential rt.'iziuuicipal/Public ❑ Industrial El Agricultural ❑
Applicable Box):
ELL USE (Check
Monitoring ❑ Recovery
❑ Ilcat Punip Water Injection ❑ 0(Iier L1 1f Other, List Use
Topographic/Land selling
❑Ridge LISlopc ❑Vnlley ❑Plat
(check nppropdxte box)
Latitude/longitude of well location
1155-1, 0 9: 428q ; g'2,;
Nearest .1 own: A 1 County e/_ fie `, c'
WELL LOCATION:
/narvi
(Street Name, Numbers, Community, Subdivision, Lot No., Tip Code)
3. OWNER: i /
AddiesS
City or Toon stale
Arta tale- flume number
4. DATE DRILLED l-J31
42
6, TOCAL,
6. DOES WELL REPLACE E`!IgfIN17Wof ELL? YES I-' FF.
7. STATIC WATER LEVEL Ilclot`Use F ° IT Above Tor ore rhIP)
A. 7
Ft. Above Land Surface'
'Ter
Of CASING IS t nr rising for,un.oa nVnr ()stow i.nrl imbue requires
•
',sluice In •ccord.uce nhlt I5A NCAC 1C .allg. %2 i
9. YIELD (rpm): s=— METHOD OF TEST 10. WATER ZONES (depth)
Amount
II. DISINFECTION: 'I'ypc_!__--- Wall 'I hickncss
12. CASING: Depth Diameter or Weight/IT Material
' it . 6..
Troll ��To FIFt.
To
To It. h1>,u,ea
Depth / Maltiin /
lh , v
From_
From
13. GROUT:
From C To
From___-
14 SCnrrlN:
(Street or Rome No.) 256-1 (�
zip Code
To_
Depth
Flom •r_ -__ Ft
Prow, To_ _ rt.
15. SAND/GRAVEL PACK:
Depth
from To -----
From To
r
I DO IIEREOY CERTIFY "IlAl
t.' CRl10(!),�IANc
L
ir.
t'.
Size
Ft._
Slot Size Material
in.
Material
(degrees/minulo/reccn 1')
Lntituddlongitude source OGPSEITopographic map
(check box)
PEP111 pRILL W_Q LOG,
Prom To Formation Deciiptifln
_ gos"
•
o--
lyych Il ON KEJ411
Show direction and distance in miles from at (cast
Iwo State Roads or County Roads. Include ttie road
numbers and common road names. w
w
apt
O
C..)
r
cn
0
11115 WELL WAS CONSTRUCTED IN ACCORDANCE WI Ill I5A NCAC 2C, WELL
, AND THAT A COPY OP'11115 RECORD IIAS BEEN PROVIDED TO TILE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING 7118 WELL OMB
OWrI REV. h, NC 1
Subndl thenrfRlnnhtvlhe 1Lrlilnn 11f hllht d0�nys`lye Groundwater Section, 1636 Nall Service Center - Raleigh, NC
216ga-1636 Plume No. [phone],

WELL CONSTRUCTION RECORD
North Carolina - pupal 'mew of Environment and Natural Resources - Division of Water Quality - Groundwater Section
17, ' / /
\\ ELT. ((1Nl It:\('1Ult (INl)I VIUUAII NAPI F,inl) ��ND D` f)LLI'OS CFR.]IFICATION a O9'r 3If1 QL<f' (.c _J YJR11- /A36— PHONE alBxi)W37^-r, "
Sl Al I. \F LIT. CONS IRUCTION PERMIT11 ASSOCIA IT'D WC) PERMIT if
(ifapplicable) (if applicable)
270770
1. WELL USE (Check Applicable Ilox): Residential Municipal/Public 0 Industrial 0 Agricultural 0
Monitoring 0 Recovery O Ileat Pump Water Injection O Other O If Other, I.ist Ilse
2. WELL. LOCATION:
Neatest Town: 711.U27/) Counlyn{'tOgOe—
,Y0TOA P2eSeR✓e 1-o t lid
{Sheen N;nmc. Nlmihcrs. Community, Subdivision, Lot No.. Zip Code)
3. OWNER: A-)Q � 'UC Shoo Le2
Addles �Z 9gf
(Sheen or Route No.)
C in nr m State Zip Code
Area code- ('hone number
4. DATE DRILLED 3—g —') 3
5. TGTAL DliP I 11: SCvc
6. DOES WELL REPLACE EXISTING WELL? YES CI NO
7. STATIC WATER LEVEI, Below Top of Casing: 2.o FI.
(Ilse "+" if Above Top of Casing)
8. TOT' OP CASING IS / ET. Above Land Surface'
'1 op of caring terminated atlor below land surface requires a
caries a is acemrllmare n lilt 15A NCAC 2C .0118.
9. YILI,O(gpnl): (2Q METHOD OETEST
11). WATER ZONES (depth): 5-1/0
/9/2
Topogrl tic/Land setting
['Ridge .lope ❑Valley OFlat
(check appropriate brut
I.atiludc/longitude of well location
talcgre cslm roues/seconds )
Latiludcilongitudc sourcc:OGPSOTopographic map
(check bus)
DEP Ill DRILLING LOG
From , To Formation Description
/ 7 0 Sim ; C4S/A)6-
/70' — S✓zn Sit iE
Q
v
II. DISINFECTION: type H it -I
12. CASING:
Depth Uiamc er
From To / 70 Ft. 6
Hum 'fo Ft.
Flom 'fa FI.
13. (;ROUT
I tote O
l ion �U
11. Sr. REF
Amount 1 Cbt
Wall Thickness
or Weight/EL Nlalcriol
$; :1 PVC
Depth Material Method
/70 Ft. Curr1 9s ✓ �avl /_
Depth Diameter Slot Size Malc' ul
From To FI. in. in.
Flom To Pt. in. in.
15. SAND/G12AVFL TACK:
Depth Size Material
I man i 1•1.
I Tom To hI.
16.REMARKS.
1, I ¶)(11.1II )2gI)Y{TiR I II 1 I D)Vl
I ( iNSDUI(' IION S TAN UAR(�,2
LOCATION SKL1CII : _
Show directrnn and distance in miles froMat leas!
Iwo Slate Roads or County Roads. lnclui5 Ilic'Rci5d
numbers and common road names. co E,
)T1
WELL, WAS CONSTRUCTED IN ACCORDANCE Wf111 ISA NCAC 2C, WELL
T A COPY OF IRIS RLC(1Rt) 1 l3IiEN PROVIDED TO THE WELL OWNER
SIG ATl1Rli,�y'1'�?7t CONSI RUCFINCi 11 IE \VELL DATE
21
Suring! (he o iginal to thedivision of Water Quality, Grountlwoler Section, 1636 Mail Scrr Ice Center- Raleigh, NC
2'699-1616 Elitme Ni, (919)).70t- wiUlin 30 days. (03,1-1 REV. 07/2(1111

WELL CONSTRUCTION RECORD 271.567
Nut Ih ('nOilii,a - I )c 1l:lnicnt of Environment and Nalural Resources - Division�of Wale( Quality - Groundwater Scclion
t\11.t. ( )l ltU IOIt (INDIVIDUAL) NAME 1(�print) J #9yi,(/J. rl'F/ J'(C KI.UN OA-) CEItIIFIGTIONN 217///�J
\\Fll.( l hN IItACl Olt (OPI I'AN)' NA'lEI h(ppn klt) LCJL.[y j jIt PHIONE N PS) 0�7 paip
S I .\ I I( \via.I. (I)NS I Itl'L I ION 11E1101110 ASSOCIA I F:n \('q I' 10I11 N
01 (if applicable)
1 \V I'I.1. 11SE ((Beck Applicable Box): Rcsidcnlialle/NItmicipal/Puhlic 0 Industrial ❑ Agiicullural ❑
P.Inuiloling CI Recovery ❑ Ileat I'ulup Water Injection ❑ Other ❑ 11(llhcr, I.isl Use
2 W111. 1 OGA I ION. �1� J
Neatest Inuit �%'Ju � Couuly_ Q;7/l
HC abea gb±'a wiz- ongS
Burr) Mulnr, Numbers, Community. Subdivision, Lel No Zip Code)
I O\VNIR: 5%LVC S2L %/0
Addics l/ g Sz °P 2D
(Snot on Rothe No.
S. i3I ibS,R ? T Q'a27 DM' I II
( ilv nr. limn Slur Zip Code Finiti 1.0
I ()I- G14g —/S`tG 30
r\i¢I a ode Plume nllmbvr .or-�,
rI_ NAl E DR11.I.ED 3-13 -o 3 .71— .S
5. Tu FAI. DI?1(111: 2'03.
6. DOES \VI'I.I. REPLACE EXISTING WELL? YES ❑ NO ICJ'
7 STAII(' WAER I E.VIi1, Below 'Fop of Casing: __//_;r1 I'T.
(Use "I" if Abovelop of Cocingl
5. TU1' ()I- CASING IS / F"h. Above I .nnd Surface
• I np nl rasing Icrminnicd nl/ur Irelory IanJ )nr(nce require)
r :u hint In nrrnnla re .Jlh I5,\ NO1(' 2C .0110.
o. YINI)!gpill):_ME1110)) FTI?sT A�
III \\ \ I Illt /ONES ((cplll)'.
11. I)ISIN! ECIION :'I ypc ° % 2e 3 Anunod _� C N�
12 ('ASING_ Wall Thickness •
Dcpal Diameter or \\'ciglIVFl. Niuctin,
ImnO 1 r1.7,)7/ IT (nlv I r 185 STeeL
troll 1+ H.
111111 I In 111.
I1 lIP0111'. Ilellh NII:Helial Nir•Ihnd
I 111111 0 lu ;20 it. &41e'dr GP-!fl/l7�
nun a_._II a7L-H.—CUr_tvis. .6Q4V
Li tic BEAN'. DepthUi:under /Slur S17e NIIIICIri:
tool Tn I'I.
'ono l 0 IT
I5. SAND/GRAVEL PACK..
in.
I )cpdr Sizc Material
nm To I'I.
I('. RI NI,\ItIS:
I ,
jl (
)liar! 113A`❑ �t1IL'V' i
DNS I RUG! I ION SIANI)✓A
f(Tograpllic/Ian citing
Midge ❑Slope 'alley OFIai
!check npprnpr inlc Ina)
I. aliludcflotigitude of (veil location
Ncgn reciminbiesiccconibl
Laliludc/longiludc source:❑GI'S❑Tupogrnphic neap
(check bus)
DRILLING LOG
Furinalion Description
RED CL±
e
LOCATION SKEI CI __
Show diroliun and (lislancc in miles fronC.ai Icn7t
Iwo Slaty Roils of County Roads. IncItid is rOad=.
ntlnihcis and ('Inillnln toad names.
IIIS \VI(1.1. WAS CONSI 1(11C 11•1) IN ACCORDAN(1'. \VI III ISA
AND 11IAT A COPY UF'I!IIS RECORD IIAS [WEN PROVIDED
NCAC 2C, WF-LI.
I O I11E WELL OWNER
3-/3r-03
SIGNATURE OP PERSON CONS IRUCZING IDE WI•l.I.
DAllii
Submit the tit igimillit the Ili
276011.16.01 Flume Nu. Illtrt-9-.t.
'shin of 11'alcr Quality, Grmmithraler Secllon, 1616 Mall Scrlice Critter - Raleigh, NU
1221, nilhin 10 days. (i\V-I REV. 111/21)01

271568
WELL CONSTRUCTION RECORD
Hun, (':oolina - 1)cpallniunl of Environment and Natural ILe*sotuceess - Division of Wale? Qualify - Groundwater Section
wPI.I.('ON II1A(-I( OR I INIIIVIIUAI.)NAME (Old) big it) qq�� �� ��4'T1c214 /5)4.1.10 CEItTWWICATION N 2�/ Icc
(tl[I.l. ( I IN IIRA(' 1On ((INIIANV NAMF. Chef019e 1cue_LL_D U LoJ I'IIONE p OiS1 KS? EODS
RIAU( w1.1.1. ('O,rSI I(1'("1ION 1'ER01I It/ ASSOUTA'f1:I) WI) l'ERNlIIX
lif applicable) (if applicable)
I. \\'I.I.I. I ISIS (Check Applicable Box): Residential E2 tvluuicipal/Public U Industrial 0 Agricultural ❑
hllmitra tog O Rum cry 0 I lead Pump Water Injection ❑ OIIIc1' ❑ I r Olhcr, LIST Use
2. \V II.I. I. WA I ION'. p /� _
Nearest lnen: l4(�(_g'` /I / County (ikE� �
1nIR -1 7-
I Cbvot Now. Nmllibei<. (lmmitunily, SubtliviFinn. lot No
. Zip, inncl
1, O\\'NI'It'. // KL / 0 S' I /^2"�' (lIcgrec<nns'inlneeconJ<)
nddlc<•: ran
r )in fox j 5Sj LAIiludeflungiludc source:O(il'SOfopagrlphic map
ISocrl tlr not lc No) /��• � Ichcck box)
/11C1ghfl �% n Y(ll DI:I'TII DRILLING LOG
t 11v,n Ii,,. �, slam Tp C'oJc from To Form;dion Description
I?21- -5' 5 - 7933 0' Reb c Mj/
Air:, onlc rhouc nnn,bcr ) p' S/Q+ii
-1. un IF ultn.LED 3•- -G-3 ' RP p u q.\ .4- Sul i -
5. I0FAI. I) ttPTGD5 I I. /_'3D' —Gf>c' . 2..1¢7-e---•
6. O(MS WEILI. Rfl'IACE EXISTING WELL? YES 0 NO CV
7. S 1ATI(.• \VAI lilt !.EVIL Below 'fop of -Casing: /03_ET.
(use "a" if Atovc'lop of Casing/
g l( )1' OP CASING IS ___ / _ PT. Ahovc ',Mid Surface+
• 11 at rad,q. lei inh,atr,l allnr below Inuit nvrnre I -cooing •
, .plu,ce In ',mil&tore n1111 I5A NUA(' 2(' .0119.
1 I1f1.D 1 @pill): \// N1En1GD OF TEsr ALK
IO AV'n1 lilt TUNES (depth):
°pographic/Land selling
Iltitlge OSlnpc OVallcy ❑Plat
!check appraplialc box)
Latiludc/longiludc of well location
LOCAT ION SKETCH
I I. I )ISINI1 ('I II )N: I ype 0-12. )RLUV— Amount , CJ.tp Slow diteclion and di.clance in miles from al leas'
12. LASING: Wall Illickness I Iwo Slate Roads or Courtly Roads. Include the road
I)eplb Diameter or Wcighl/19. Material tltllllbrl s :11nl common road Ila I11CS.
1 film j Ilt_132_ 1:1. CO )si" :SCR 21 _TIC
I !MITI Tn 1.1.
I fluff 'In Irt.
11. (I 12O111 : Depth Alalcrial 1� NIclliod
1 torn �(3 fo GQ 11. (( f''- 1e43 r _/L'_-€-1�'lpeb
1 I„ol_-C i1__ Tn - i j 3_ II..S.M rn:VJs �'1 i�A'JLT>/'
14. S('RIIEN: 1hplh Diameter Slot Size •l/) Nlntcl IRV
!firm 'fo H. in. iu.
I1„ul To ft ill. in.
15. SANIVGRAVIII.I'A('K:
Dcplh Size Material
I tool to f1.
Form 11t 1'I.
16. Kf. /ARKS:
I I U1 111 1 1?01' 011 II 11' I I
((INS I !tilt III )N S I ANITIN t�):
'4i
I-ilAv�as�'c'-
S
CIS 11111.1. WAS CONSIPAJ('l I'U IN ACCORDANCE WI Ill I5A NC'AC 2C, WELL
Nt) II TAT A COI'Y-Or i I CIS Rf('01(D HAS 1ll'FN PROVIDED TO TI IE 1VELI, OWNER
SGNATUREOFPERSON ('I)NS11tUCI1NU-IIIP.W1i1.1. UAIE
Submit the ut igin:l to Ilse Ilivi. Ion of \\'Ater Quallly, Groundwater Sccllon, 1636 Mall Syr%Ice trifler - Italclgb, N('
276991616Plume Nn.(919)7t,t-1 21.1%1111in3I111a)'S. (1W-I REV.07/2001

\\l'1.I. (I)i\ 1 Il:\Cl till IINIII\'InkIA1•) NAME (Print)
111(I 1. 1'(IN I !IA( ' 11111 (11\IPANY NANII'.
S 1 ,1 1 I. w'f:l.i. C(Ir's 11 'CI ION I'EItr I ITN
1 if applicablcl
WELL CONSTRUCTION I{ECOlill
Nmlh (':uMina - Derailment or Environment and Natural Resources - Division of Wnler Quality - Groundwater Section
LT, /�C/<I'iti%ON CEI4IIFICATIUNN �/
il1QRoke) kIALRi11IN' I'IIONE Si13;15)SS7-_8Q( ;
ASSOCIAI El) WI) PII:1 \IITq
(if applicable)
271569
I. \VI i.I, IISF. (Check Applicable Box): Residential L\S Municipal/Public ❑ Industrial 0 Agricultural ❑
NlimiIoI imp ❑ Rccoccl) ❑ I!cat I'uugt Water Injection ❑ Olhcr ❑ IFOlhcr. List Use
2. WELL I.()CAIION: 1 /�� �" � f
Neatest Town: .�N�J7 �h��� - County L _APJ2- �/+�
Erb OF 6P-1 ITe--44^)E
Door! Nmnr. Nllmhrl5, (mnmunily. Suhdivisi:n:, Lol Nn., Zip Code)
_-, // _ C'�Wei L
Addles, 643 �Phh �ALI� DR,
(Snot nr Koine Na.)
ores reR 771 / 2L 30 G
iw or lane State lip Code
(Kg I- GYy— 9 /83
.\ire emir 19umr numbs:
DAIF•,I)Itn.l.EI) 3--�i—o3
5. 1O1 Al. DEI'TI I: ao -/
6. DOES \\'Et.I.12EI'I.ACE EXISTING WELL? YES NO (Jt"
7. S I ATI(' \VA'i Ell I.IiVE1, l3clo\v'lop ()Teasing: Q_FT.
(Use "1" if Above I'op of Cnsina)
R. TI t OP ('ASINCi IS j FT. Above Land Surface;
' !nu of nich:a lee al/or below Irma on face requites a
r a: lamer In ntrord:mre sr111, I5A NCAC- 2C .0(1a.
1). YIFI.I) Ip1lu)' V MEIIIOD OF TEST /4 L2
I 1 WA I ER /ONES (depth):
Topographic/Land setting
❑lodge ❑Slope ❑Valley Ial
(check appll'primc bm)
I.ntilu(Ic/longitude of well location
Plcgrres/ollmiteosecuuJ1)
Latitude/longitude soulcc:❑GI'S❑Topographic map
(check bus)
DP.I'T11 DRILLING LOU
Mom To Formation Description
Ci J L QeA C -
%31 2) NTT
[9- nu L iC
1I. I)ISINIF(7ION:Iy'c I-/ L 1-I Alumna ____L Cu�i
Wall Thickness I
Depth Di:un ter or Weight/II N aleri;l
I lam To__,_ FT'1 Sp/2,2.l pi,
l lanl To Et.
Fenn .I.n 17.
Il. (IRI)ll1. Depth Maietial ' Method
12. CASING'
LOC:A II�)N SKEI-CI I
Show dirculion and dislance in miles froul :d lead
Ivu Sl:llc Rontls or County (toads. Include the road
uunllcrs and common road names.
too-_- (� 14, II. C�MC�^ 7 = l/l r
1::111 To 1't.
II. `:I It FM) Depth Di:nncicl Slol Si7c - Nl:rHai
Il inn To H. in. in, ._____—
Ilone TO II. in. in....
I5. S,1N1)'(iRAVI'.1 Mc 1:
Ucplh Sizc M:aclial
I lno to 11.
I low 10 It
IG. PI \Rf:S
`I I L..
I-F))P �I91
CUNSI IUI(' I IUN STANI LA 4I )i
1
CD
(J
_'
\ores��
1
\ _
IIS WELL WAS (ONSIItII('I El) IN ACCORDANCE WI III I5A NUAC 2C, WELL
ND TI IAT A COI'Y OI°'IMP: RECORD IIAS BEEN N PROVIDED TO TI IE WELL OWNER
IONATURE OF I'I ItSUN CONSI ItUCIINU I111,. WE1.1.
UAIE
Snbmil the oriiinal to the Iis slim of 11'aler Quality, Grolnuln:der Section, 1636 Mall See lee Center- ItnIrIgh, NC
27699-1636 I'hmtc No. l')17l l 3- 221, n1111lu 3(I days. GW-I ItliV. 111/2001

DRILLING LOG
City in I. n SAr� a Zip Code I-orurlliolt Descripliun
,- g 'r-- 7 — Saab GI�J�eL
WELL CONSTRUCTION RECORD
271570
Not ill I luulina - De rninamt of Environment and Natural '-/
Itesoouiccs - Division of Wale!. Quality - Groundwater Section' /
(-r)1.'lli:\C!Olt (INIII\IIIUAI,) NAME �(prrllt) DAVI b�F (,'r KLA!init) CERTIFICATIONII 2//
writ .(TN'III\(IOII COMMON' NAME_l Lose kee l./t��I1 )R.,; 1j rIIONE IS ff4)Vj7 -800g
SI.\II'. \\FII, ( (I SI Ill'("IION !TRAM fl ASSO('L\I En WI) rEIthIIIM
(il :ggdic:ddc) Or applicable)
I. \VI -I. I.IISIi I ('heck Applicable Box): ResidentialiZ( Nlunicipnl/Public CJ bullishial 0 Agricultural Cl
bloniloling ❑ Ramer), ❑ I;cal Pump Water Injection ❑ ()liter ❑ II'Olhcr, List Usc
2. N atest IIwti: N'. K
Nrncsl lfoA\en:r1.1[JZp'r�yl County
Itin(ct N::nm. Nl,//mhw c. ('u nnlnnily. Subdivision. Loi No�...� Zip Code)
I) NIIt ylekco kw' KeS0P_ 0-1. ay
Addl css Q 1
"Topographic/Land selling
Oltidge ❑Slope [Walley lit
(check appropriate hart
�Lntiludc/longihule of well location
r itegrec Oninnies Istc l ll ldr)
Latitude/longitude somee:OG)'SOTopographic map
roe)" haute NO.) (Cheek bn4
III. WAIF); ZONES (depth):
DLI' 111
flnm To
pS6 3 `�
i
.41r r�vlc I'h�n¢nlllllbrl 1' _I7 - � 64J@ 1 f C,
.1. DA I I'. D12111Ilu_._
5. 1 (1 IAI, DEI' 1 11: 1-a
6. DOES \VI?I,I, ItFI'I,AC'li EXIS LING WELL? YES O NO g/
7. STATI( WAIL ItIEVE!.Below Top ofCasing:__Sc. E1.
(the "+" if Above lop of Casing)
R. 1 WI' or CASING IS � ET. Above Land Surface•
' I np of casing Itnnlnnted at/or hrinsv land rot fate ttqulrrr •
:llanre 1,' nccord:Iyyce .ml I5,\ NCA(. 2C .011a.
9. IIEI.1) Memo) _V5 __._ nun IOD OhTIES 'I. f / R
7'
_ LOCATION SKE I CI I
I I. DISINIEC IION: I ypc ( ft1-t?Q,We- Anmunt % C_ U Show direction and distance in miles from al least
12. CASINO: Wall Thickness Iwo State Roads or Counly (toads, Include the road
/r��0� Depth
�`� (D�JJJ'_�a�iJeli�trr or Wcl'hl/1:1. M•. a��t``cpilial numbcls and common road names.
rI PIII V 1, C3(` II . la/4 • f S Leer- ._
1 anti It) I'I.
I non lt, Il.
II (;ROI11Depth Male( ial Method
I win0 To;.--)1_ I L Corner-JrJ�
Id. SI' ItP1'.N- Depth --� Diameter Slol Sim NI:,ie,iil
f ono To I t. in. in.
1 row to 11in. in.
I . SAND/Car AVI'I.PACK)
17e1)111 Sizc Material
I toolI n__._.. II.
I nqu Io II.
16. REM,ARKS:
ra 110RI\j, l' ();1112-
i�S1iiL1 IIi 1 S
SutIJ. ilIIic_uriytiAal lu
2)fgq 1(161'Iu11Jc Nu, II
IIAI "IIIIS WEI,I, WAS CONSTItIIVIlk) IN ACCOItDANCI. WI Ill ISA NCAC 2C. WEI.I.
AIU)S, AND IIIAIT A C01'x OFMIS I2ITORD Ll(\$ BEEN PROVIDED 1O1IIE WELL OWNER
SI(INATt11ti OF PERSON COTSII01CI INO'IIIE \VI!I.I. DALE
he Division uI Water Quallry, Crouudo:der Scellon, 1616 Mill See sire Center - Raleigh, NC
I)) 7.11-3221, within 111 days. (i1V-I REV. 07/2001

271571
WELL CONST1tUC ION 1tECOItll
Nol lh (":(rnlina - Dcl+ mien' or [Environment and Natural Resources - Division of Water Quality - Groundwater Section
''7T"�� ID n/n)O ,J 2/�
1-nnl It A( pN UIYIUUAI.)NANi/?�(prnnp_�/•r� �/ i' ImGhl CFIt7l FICAA�"FSI�UN NI.[ O
IU.I. IUN I It I Ott ('1)NI ('ANY NAME: l ckt�'� rA.A'�(( /JQi 1/Ia�J I'IIONE N 'W) g37g(�O
S I,\ I f \\E:Ii. (().NClltl'(rI ION FERMI VI ASSOCIA'I El) WO l'E:WsllII/
1 if applicable) (if applicable)
1. \VISI.I. IISI'. (Check Applicable [lox)' Residential 1/Municipal/Public ❑ Iuduslrial f7 Agricultural El
M oniloling Cl Rccmcry El Dent Pump Water Injection O Other ❑ IIOilier, List Use
2. \\'P.I.I. I c)CA IION:
Neatest Town•(r(ma,
CnPG(•-.
Corm!), a te-PrA?ke_
(Chet Name. NwnLci s, (wnmunily. Subtlivision. 1-ol No.. Zip Cede
:a N
Addlecey�7
7� (Shin[ 'r Ronne No.)
_DUS4t Nei t ,�I 3 3
l'ilvm Imrn Soto Zip Cute
133- 303 — ')'746'/'i
Arr.' orde Plume number
.1 I)All1 ultn.LPD 3-PI -03
5. 101Al DE13Tl1: 5f5--
'
6. DOI'S WIILI. REPLACE EXISTING WELL? YES ❑ NO
7. S I-AIIC WATER I.EVIEI. I)clow Top of Casing.
(Use "4" if Ahovc Tap of (inning)
5 1 OP OE CASING IS / FT. Above (.and Surface'
• I up or rasing Icrndmrlrd •Vnr below laud nrrrnce ttqulrn •
r an lance III nrrord:umr %Olt ISA NCAC 2C .0118.
Q. Yml.o(grin). o5MEFIIODOFTEST R/2
ID. WAIF!? J.ONFS (deplli):
; 3c
I I. I/ISINFPCIION: 1 ypc l LIALp2t'C AIRnuIII 1 OAF
12. CASING'. Wall Thickness
,�rr••--�� Depth Di:nn''c}ll r or Wcigld/PI. yMMaterial
11nun_y To-.-3a FI._� i )J $DE2 ,�[ Tvc_
!low To It.
nom To 11.
11. (112111J 1`. Dcplb Male,ial 1\lethnd
1 10I11 'U.-_ To O Ft. �cp-mPn)T 5RA✓i
Id. StRFIIN' Delia, Diameter Sloi Size d Nhr.clir,
1 nun To Et. in. in.
1 tool To Et. in. In. _ __
15. SANI)/(iRAVEI. I'A(K:
Drynh Size Material
I lam To II.
Erma 1L 11.
I(.. RI`MARKS.
'Topographic/Land setting /
❑1(ulge DSlopc OV:IIICy Cdf`l:)I
(check ripplermale hurl
Latitude/longitude el well location
Idegrecshniuules/second<)
t_ dituddlollgikalc I opographic map
(check Dom)
DRILLING LOG
Formation Description
DEPVII
Flom To
iQD
mil)- 5-1
57 _ 7145 tRA,uLYt�
LOCATIRJN SKEICIl
Show dirccliuo and distance in miles from al leas(
hem Stale Roads or County Roads. Include the road
numbels and common mad names.
14Y)M PFUVITRtIII I
TriNS-rRlICTION STANT57I
115 WELL WAS CONSIRII(' I nil) IN ACCOItDAN('I? \VI III 15A NCAC 2C, WELL
ND TIIAT A /O.OPY OF'1IIIS RFCOItD_IIAS BEEN PROVIDED 10 TIIE WELL OWNER
(CNA 13112E OF PERSON CONS IRUC LING 1111' \VEI.I
3 2 7-03
DA„i
�-S
Sn)mlil the tit In fJnc Din i tun of \\'aler Quality, Grnuudo Alen Sccllnn, IG36 Mall Seance Gelder - Raleigh, NC
276g71636 Phony. No. eft)r I - 21, within 31) da)s. (iW-I ItEV. 07/2001

272338
WELL
rr„ O r
No11hot On - Ucpalhnp%1 of I'awhomucul nod Halm al Resources - Division of Water Qcr•-••a., - Iouud�^ cr S2e.1101,
rinp \ n C�
a al, CUNT RAOOlt(INmenNy nu UAL)NAMF. Ip l—t•11. C Miele.. a Cal O
w ELt, CUNT IIACI(11t CONIFANY NAME, M �10_�
ASSOCIATP,U IN RP.IN111M __------
S IAfE iPF61, Ia Lcnbk? 10N PEItNII IN__--
i(ordINr
I o I dicoble
icable
Applicable Dux): Residential ( Municipal/Public ❑ Industrial LI Agricultural
LJ
!. WELL USE (Check A{ l Other Li If Other, List Use
hlouilotiug ❑ Recovery ❑ Ilcal I'uugr \Vnlcr injection lJ 0 ,hnitl/glnphic/Lntnl selling
LJltidge LISlope ILVolley UPlnt
(check eppl np,lnle line)
Lnlilude lotigilude f 3 l�location 1
N3s:io;s/—� 6 --
(derrreJndnulrels-`-nium
Lntiludc!!^nellude source:n (check
-Fopgl oaihic In
1)IULLIIJ(J I.S$i
1� tLLll
plum To I°uma ion Description
tl - If7
e
2. WELL LOCAfI )N:
Ncnlcst mv:
(Street N,me• Numhen, Ca:::r... Subdivision, Ud No, 7.Ip Cale)
County
J. OWNER:
Address 1Lx _J-- 0_-� L\Q--
,��,,,�� (Sneer al Route tlo 1
`i c iXVt-------zlp Code
City oflonif Slnte
Alen care- Phone number
,1. 11A1 P URILLII.0
5. 10 T AL D li l' Il I: _X-t1S-'
6. DUBS W EI,L Iij 1'I.ACE EXISTING WELL/ YES Li NO Ir. tu--
7. SfA7{C WAIER LEVEL UeIo`(� e 0- f Casn: If Above Inv of i„a)
P. 7U1' '5 CASIN(IIS _- --
_ PI. Above Lnud Sullilce'
•lcp of rnlmr lennhrvlyd safer hrloa Inul ruffle rrq ml, rs
•
rul.ocr hr 'nonfinite with I5A I1S A lOU OIII'I"I:ST1{t..:L------
O. YIELD (gPnl):Q --
Ill. WA ER ZONES (depth):
44
I I. DISIN1ECI ION: "1)Pe
12. CASING: hcl:th Dinulcler
f rnnr____Q_--
1.0 //a' i-1.f 2S
hot
fo_ It.
not To_ IIPerth Mate I Method
pr,rnl
Il. CiROUf: r I1. ��,
fmn1Q_1o2_ .-------
.Lo_ _ __---- Mntcr!nl
I"role_ It._ (Diameter Slot Size
14. SCREEN: Perth Diameter
II iu.
from _ 1" n in. -_— in.
hoot__ _ 10. _. _—
15. SAND/GRAVEL PACK: Morello!
Droll% Sire
To I1
To
hot
f1.
Amount
Wall -thickness
or WcighUPI.
show rlirecti0n and diainlner i11 II1il('s fioln nt Icast
two Slate Ronda or County Ronda. Include the road
t.Intcr inn numbers nod common rood unnlcs.
a RKS: WELL
1
r
[.") I Do III hrn� clt' ' plUAltl)5� A1JU I WAS
CO1' or Ttl S ItLCORD IIAS dEGN PIIOVIUEU 1O711L' \VELLO\VNER
ff cons IRUCIIO)IS� �- /�-�-
1 DALE
SIUtJAIUIII! 01' I'EIlSUN CONS11tUC11NO 111E WELL
LAS'._LL'Inn�(I(ejiInn% Ulvldnn ofWriter fool%% , Crfloodwater Salmi',
1636
Mall Service I- Raleigh,
b,NC
1617a-67bTN' (9191133-3131,Pithily 311 days. REV.01111
1

272335
WELL CONSTRUCTION RECORD
North Calolioa - Depallrneld of Envilmuneul njid Natural Resources - Division of Wider Quality - Otouadwnter Section
�'1Y1 CERIItICArION e�4U
(CELL CON IMCIrIiI (INUIC'IUUAL)NAMF. Ip,lw ^'I 9C g11UNP, e
WELL CON MAGI 11R cony/on NM1F,
ASSOCIA1P,1/ IV() rP.RMI IM ___.----
lif anplicablc)
51A Irk R'ELL CONS It lIC1 ION 1' ERRIIie
if n r dicablc \Vfi Ll, USE (Chock applicable lhra): _- / ---
Il ' I lint Ilia Municipal/Public fI Industrial Ll Aglicullur al
2. \VEI.L LOCA FION:
Nenfest *1 °will
6 Z f ail%
(Sheet New Iurntrfr•
vyr/
3. OWNER:
�Z grva7-
ndchcss
Pled of Poole Nn )
ea1Ciry Stole zip Code
vat la,
can rn
Monilotiug U Rccovcly U Ilcal Pump Wnlcr Injection U Other U If Oilier, Llst Use
'Popoglaphic/Lnrld selling
lOgidge ['Slope 17Vnllcy UPlnt
(check epp,nprlale tine)
Latitude/longitude of well location
�
(deg,ree/wh,nleds^cnndQ
Lnliiud-f!r,Ite'lude source:UOfSf_1"fopogwpbic nrgl
(check took)
DER -LINO 1, 1Q
otn)aliotl, tcsctiption
county( as
A
,,,,�••,Iro. Su6Ji vision, d No., Zip Cale)
A,c• calm Phone nnmbe
• 11. OAtE DRILLL•Il ---
5. I OTAL PEP I IL 3QS______ ____
6. IJDES \VELL REPLACE EXIS IIIJO WELI,? YES F. UU NO Ily-
7. STA"1-IC WATER LEVEL ((claw Top I1'• I1Abovesop of Ce,h,g)
g. .EDI' OFCASINO 1S _ _1— Fr . Above Loud Sot face'
• Iry rl r•,Inr leindoatt1 •Erne Lrlrn I•nd van face rrgnhn •
,valance In •cordon�(1,„ IIh IRA NCAC IC .0I1,.
0. YIELD (gl'III)'_ya(._-_— F1E1IIOD DE I ESE ---
IU. WA f ER ZONES (dcplh):
p LJtUi
now To
Lit
—
1CIS : ION: )p4-}hp�mamd _5..—__—_
12 CASINO: Wnll'hickness
tlrplh I )inoteter or \VcighUEI. Mulclinl
(roll To PI. ars5_1
1.0 li, L it /a (7
I'Iom __—
limn To I`L____— _MclhoJ
'krill' Mnlcti I
u. (MOO IV: Sri.-n
now_ __"Ir'— ''1. -- - _._ Mnluinl
Id. SCREEN: PcplIt Ditunetcr Slot Sir.c _
I"Ioul t 1'L_
in. in.
To_ _ 1"1.
in. iu.
15. SAND/GRAVEL I' CK: Sire hlntalnl
ToR.I'tol❑
ft°m
1"0_— I1. —�-
- 1,f.EJLE.I*nK*
l ^ L� I� ll III
I O' HEREBY crl}
CONS1IWOION Si
L )cAI ICIPLS EJ-Gn
Show direction nod distance in miles Dom vat least
two Stale Minds or Colmly Ronds. Include the toad
numbers nod C01111no❑ fond names.
0
Cr/
GA OI
ASr C �'i�c�c%hun14 the °YInt o to
1169a"1616 Pliant No. (419) 733-3/21, nilhin 30 tiny,.
11IA7 11118 WEII, WAS CONS I IIUCI ED IN ACCORDANCE \Vl'I1I I5A IICAC 2C, WELL
)ARDS, AND 111Af A COPY DE'IIIIS RECORD ILAS BEEN PROVIDED 10111E WELL OWNER
S-1611A1 all PERSON CONSIRUCIINO 111E WELL
the Dhlrinn of Wein Quality, Groundwater Section, 1636 Mel' Service Culler -11IEVRli1 20

Nollll Catalina - Ucpnllulcul of Euvllonmcunod Nnlu.�� enoulcen
II Fit COON I IUCI hilt INIIIV'IIIOAII NAME titling L
VP ELh coy I ItACI Ull CUM rANY NAM F.
S T A I E lc ELL CONS 1111ICI IIIN 1' EIRPI 111I __.____
n„oar
N'pl,l, IISIi (Check Ptl'1'11`"hla i1na1 Rcsidcn!In• I • L ghcl U If U16cr, Llsl Usc
P.eenccly U Ilent romp \Valet Injection L
plmlitcniug ❑
Ligh t, UVnli,.j im.Lri
Ncnlec lanlll:-------
1-IfllluddlungiWdc of
well lucaliuu
I rq Nwnlrtn, C� ...• Ilr. SnFrlivi.lmr. Ip1112, 71p Cc.lr)
C alike •15 (,,/go[ wet p3
rtiret
/nI ,1/�1y-� C�V Vl-.o-Iilulcrl..ugiludc soluceLllll'SCI fapoRtnpbic n:�'p
J. O1V IJl'It to 1-�- u-'_ �YTQUa 1� — (check M.)
Mldlccs II[tlLLlrJ1l 11JO
ISlrtd of Poole Ile) I)L�'_lll
pile --- .I.0 uoI. liun ' suiplion
___-- pI IO at
�( L4�_�-�---Shoe nra,dr �-
C{Iy of lanl
11'LL CUN51'1tUC'1'1UN lllsl iii:.%
Ulvlslun of Wnlcr Quality - (houndwater Section
\S+a cE.ItIIFICAIlUtt c'241C�U
P II UNF. L_:J-Z~1 I
ASSUCIA 1 E1) W(1111011111
if n r dicnblc
•I 1' llc
t ( Holt 17 ludush inl I APricuhutal LJ
Inpngr.,l (idl,mltl.;;.Ilin1:
2. AVI!LI.Ll7l.Alll)f1' County � IJIUJge I d''11'.)
( hSl i nplmgr
VNUc -�
nSlHut)UI°
- Itsf
J.,
11. I)ISINLIICFION: 1) Pe
12. CASINO: Itcpol
.tom fn ( r PI. ( aS
Ii0hIl -- I.1. —
Ilmll In _
\'Imo__ to _
11
�a!�
I.—1tt�—FI.
Ik Ih Ulmnticl
Id. SClt.I?IRJ: P In.
El _iu.
Ilan= _I"—_ --1.1— ilr lu.
Ilool- 10—_____
15. SAN1J/UIIAVIi1. PACK: Sire hlnlulnl
Urpol
1i i
Ilal° FI.
Ilum 10
Air. adr. I'hrnr mmuhr�(
4. PALE 1/1111.L1'.17 �4 .--_.-
s IULAI, PIA' 111_ LL„' 11;lly r•I1 I tiESU iI() U
6, 17UI?g\VI1L1.1/l'I'LAC'. �.n.• ,.`...-_ b�-- pf
(tl(e' C' If Above Iop of Crtilnit)
1. SIN! IC\VAIEll LIiVELUelow Iopof('ashy,'_
P f. Above 1.nnd Sin li(ce•
R. 1 Ir ill"CAS CASINO IS-L__a.
• I rr ri c.J,q ltll, t l,a .Irr, Won nd nn l•ce lerpdm •
IC non
,ul,nc, In our, d.n e Pith IRr
o, 1'Ifi.l) (Fell') -:
Ill. \'Anil( ZONES (depth):
1
I.Ini tint
I1.CDOUI • 'krill nn'Y�cltlt
•
Alnm Nl _ .�—
Wnll I Idcknrse
Antonin let 1Vci pl. Material
Cca
Mell, od
I t m , . ______
I'1 _ _ hlnlcrinl
F1mn-_-- 1(' — sip' Site
272334
LVCAIUIJ SKJJ-I ( \-
Show direction and distance In wiles Flom nl lend h
hvo Slnle Ilolnls or CnuIIIY Dada. Include Ilse innd
IIu11111C 19 mid common rand owes.
fV Lvi-a
16.REM AIII' Siil\VI?Ll.
(ji I
�111tYlltttllh hFlliK9I1 IAF.AIIJl'lIL\VAS CUP? or
UIWII 1tUEUIiCE't VW VIICAC 2C,
1nr,-IIIIN ,lh1ll1NtUS,AND I11AtACUP?UPluisi1ECUItuIIASDEMII'l(UVII)L'IJ'1U111L'WELL OWIIER
(� CU1iSin -
- — �A18
1. ,-UNClll RUG' INC/ "I Ill? WELL SIUNAIUIU! UP I'CIlSUi. (.�• - (.I„!r rIC
F'nnkf-ii;.,..,. ,
UWr It;Irl .0c
WWII
L� C.' ' },il nl In he blrlllnn ul Willa ()wilily, CnrunJlrnlcF Section, 1636 Millvvicz i
A:r' [` L I-cII',Iv hob
t. pi 1 ollhlti 311 dn)'s.
� n,'Iv -IhJul httir
9) 1J1"1111,

WELL CONSTRUCTION RECORD
272244
Nor ill lluolina - I repairmen' of Environment and Natural Resources - Division of Walcr Quality - Groundwater Section
„II LI- rev! um. 1 OR (Iwulvluunl.)NAME If(`r%)1m) ✓l� fF 1n�C�K^I^)'1�)1� CERTIFICATION N D 4II 1
"ri 1. ((JxIIL\1I tot C(nll'AN\'NAME ( Y L )e1I f.11=LILr.'�-� _l'IIONE d 1618)1.17—Y
S I ,\ 11. ,\la. 1. CI)ASI let'CI ION PERMI lit ASSOCIAI En \VQ I'EI III
(if Applicable) (if applicable)
\\'I.I.I, 11SI' (Check Applicable Box): Residential Municipal/Public O Industrial 0 Agricultural 0
N h,Ililollog ❑ ltcco\cry ❑ Ilea( Pump Water Injection Cl 011icr 0 If Other, List Usc
Neatest
CountyGte Q
C2VII.II CA IION:(- _k r�, OanEs s 1LD
;nog I Nnrne. NI bcrc.l lnnumnily, Srbdivisinn, Lol No.. Zip ('udcl
1 ()AA NIIr.
I)
I11. \VAT Eli AONES (dcpldQ: /e0 ) /90T
CCRy tJy
Addlcsr L.l_96' 0_ bt>y �
par
711 �•[}{�{�`n eor Rontc_Nn „ 9O \/LJ-
�n
p p1 ilr rn I�,�/,�II [/� SIN/C�J Zip emit
,Arr.r rime Phone number �q }
1 I)A1 DRII.I.EI) y-- -o3
5 TGIAI..DEPTTI'. 5.;
G. DONS VVELI. RIII'I.ACI EXISTINC WELL? YES Cl NO
7. S I ATI(' WATT[Ii I.INVI 1. Below 'lop of Casing: SD FT.
row "+" if Above Top nr Cnsing)
g. I r )1' 01CASING IS / FT. Above Land Surface+
• I np of r-.nhrg ter ndnnlr,l al/ur below laud turfoce require. 1
ar hnlrr hr nrrordnrcr nllh I5A NCAC 2C .nl la.
YII] I) (pinny %5MI fIIOI) Of TIiST f/R
II. UI,SINI FCIION: T ypc CkL Avue
17. LASING:
Ucpol Diia^nre cr
I Iran--(r) •Io y I' I. /c7 ;
is
Klemm lo _ 1'I 1 row'fn FI.
I I (iR(tU f "�•Ucplh Nlatcrial
IIolll ++��-_-_( Itt:2Q_11 Ganes)T "�,{r /1�
I 1 mm .2Q Tm 9Z H. Cher'- _c Al in
1.1 S( IiIF.N. Dcplh Uiamlcicr Slut Size r/ Nl:ucli
I tom lb I I. in. in.
1 tom 1 o PI. iu. in.
15. SANI)'(iRAVFI"I'A('K:
f)crill Sizc Mntcrial
Tupl,gla is/Laud selling
[Midge , lope 0Valley plat
Ichrck :tortoni ialr ha.)
I.oliludeflongitude of well location
Idcgrrc/1'' nines/secnds)
Latiludcflongiludc soulcc:OGI'SI:Topographic nlap
(check hoe)
Dlil'TII DI&ILLING LOG
Plum 'fm Formation Description
PaoQr
-- 75
{�-9�
LOCATION SKETCI I
Amount 1 Cup Show dircclion and distance in stiles limn at leas)
Wall Thickness Iwo Stale Roads or Courtly (toads. Include the road
or weight/PI. Nlalerial ❑umbers and common road names.
Sital
I into I n I:1.
I Ion la 1.1.
16. ItLNIAI(KS:
CP-QC�
�1 1
33 [�
ljiyunhl l>l�l (Tv ltv 1�swill ELL \VASArnFt) IN coNs e Ft) ncltu conNc r• WI II I5A NCAC zc, WELL
(434,c.1-21N 1-141id-'tAMl
ANI)111AT A COPY OF 11115 RfCOItD IIAS BEEN PROVIDED '10 11113 WIiLI. OWNER
SIGNn11112E OF PERSON Cr INC I RUCIIN(i 1111: Will 1, DA Ill
Snlnuil theorigimaq, lil"Yhc I)i'slim of IValer Quality, Grvwldn Mee Salton, IG36 Mali Scrsire Coder- ItnitIgit, NC
276'19 II11G (Tamp Na. 1(.P)) 7)
3221, n1111in 30 days. GW- I REV. 07/2001

WELL CONSTRUCTION RECORD
Ninth (mama - I )cpalnncut of Enviroomcnl and Natural '2i1:�ssottrc('ess - //D1niivision or Walcr Quality - Ciroundwalcr Sections /
\'I:I L I IrN I It-\(' 1011 IINIIIVIIWAI.I NAING/f, whil)AJrf� Ib F. J'1�f,,,, 1Jo _) CErt'I' IFICAIION If .�. —)'1
\I II I.I IINI n.\( I(III COdll'AN1'NAI\IE ( �L�� F. I�L_DRI'(fV� I'IIUNE M )g %gQcg-s3
.SitII' wr1. l.(I) SIItl('I11)N I'EItMlI$ ASSOUTA'lla)WI) I'I:10111f
I if n)'plic:Llei (if applicd>Ic)
272243
I. \\'I I I, I IS1' ((fleck Applicable Box): Residential V Municipal/Public ❑ Indust, ial O Agricultural O
Monitor log ❑ Recut ery Li I leaf I'mnp Water Injection O Other El II f )Ihcr, List Use
2. \VI'I. I. I.Ol't\-I ION'. /
Neal csl l Emir ,416112P A I County Cl1eRO e
LOCI—IreAgQ1, la_ LQ,M
I •:un l Name. Nuvbc,s. (lnrn nanily, Subdivision. Lot No.. Zip Code)
OWNER: POBEIZ- uP low
Addles,:`92o6 omP4130 /-04. 1�
(Snot ai Route NO
A 1_met'ro , F L 3'122J
iCadenr �n 1„t.n Slab Zip
82(1)- 7•22 _53 j
Ares u,de I'hoee ntenhe,
,1 I)Al It Ultll.I.lil)
5. "IUTAI DEPTH: Go52
6 I)OIS \VIII,I. RI',I'IACL, EXISTING WELL:? YES ❑ IJO (J'
7. S 1 AIIC \VAllilt I,I:\'lit, ficlovv Top of Casing: _!)i0% FT.
lose "a" if Above lop of Casing)
S 'I O1' OL CASING IS / ET. Above Land Surfncc''
• I np of rntlau Ire adnalrd altar bclmv land surface requires
, nolanre In nrc. rdaacr unit ISA NCAC 2C AI IR.
u. 1IIf1,I) (L'pu0: _...._-- METIIOI) OF TEST_ /5///2:—
111. \VA I ER TONES (dcpiE):
*I crop 'Bing
[Midge OSlopc alley OPlal
(check appl opt isle hot)
Lnliludc/longitude of well location
Idegtecs'minm cs/s cconds)
Lnliludc/longitude soulcc:OCil'SOTopographic map
(check hmn)
iiki'l I I LLINO LOG
How 'llr Formation
lJcCni ton
R2e- /
3`1`-6c)5 ,SLA"76
11. IIISINII[(TION : I vile /oa,oe Amount /
I . CASING: Wall 'thickness
Ncplh Ui`imVI/cicr or Wcighl/Fl. bllaalclial
I loot_ 0_lo :/
3L _Ft. COLSSI) a[Z D-1 Pvr
Inm II/ 1:1
1 TWO To Fl.
1. (IROUI: Ihpth NIaIciia NM\clhol
I ono CD .In il11
3 I . CP rrt�,slf_ _ J�`L.— ✓ly
I tom Io II.
1.1. S(I I_I II: Ihplll , Diamcict Slut Size Nhdcliel
1 tom Ib 1.1. III. in.
I into To • IT in. in.
15. SANI)'(iIPAVCI. I'A('K:
Ucplt Size Maletia
I nmt 111 1:1.
Mont to 11.
16. RI:NIARKS:
LOCATION SKETCII
Show direction and distance in miles From at leasi
iwo Slalc Roads or County Roads. Include tie;rond
uund)cls and common road names, o -_
)4LtIl tl Di1 itt Il!fr61 C1VEI,1. WAS UONSIRl1CIpl) IN ACCORDANCE WI III 15A NCAC 2C, WELL
tPiS IR-N4.iliitLS1A 'LX )HINT A COPY Of'1111.5 Ill'C'ORD IIAS BEEN PROVIDED' ID 1I IL' WELL OWNER
n1? r,-rt-_ / -03
AA I LIRE OF PERSON CONS I RUC I ING HIE Wlill. OAll'
Si iyrn}t-(In to i0-1+41-111LIww-LIIFISIn I of 11'ater Quallly, Grounds aler Secllon, 1636 Nall Ser\Ice Cenlcr- Raleigh, NC
27691- I6161'hotir, Nu, f')'IW,')'4L,j,1-122 , w01111110 days, (iW-I REV. 07/2001

272242
WELL CONSTRUCTION RECORD
Nlnlll ('motion - I )cpaiiment of Environment and Natural Resources -/Division of Wale'
('l(111 U L1 L I I1N I \ ((INDIVIDUAL) NAME )1rluat%iy_l l) 1\1b E�1 JC4K,t`''� 1N O,J
\1111. I 1 hN I IZ\I' I Olt ( I IPI 1'AN 1' NAME lle,�KP R'l�—.�X+II �
S I AI I \\ Il 1. ( (InSI Itl'1-I ION t' ?RM1111
lil appliclIIe)
Quality - Groundwalcr Sccliml
CF,Il1lFICA'I ION N e hJJ'11
I'IIONE 11 rv"a) 537 ^P LC�
ASSOUIA I EI1 WI)I' .IIPI I I P
(if applicable)
I. \VIII. I. IISI[ 1( heck Applicable Box): Resi(Ieulinl CW Municipal/Public U Industrial 0 Agricultural 0
loniltn Mg ❑ Rccmcry ❑ Ilcal Pump Water Injection O 011ict U If OIher, Lisl Use
2. \\'fl.l. 1.0CAI ION'. I
firmest town. /)11,1 L./J County
IJe)1 m r 20 S S&
1Snevl llmnc. r p iet,. 1'nnnnnniiy, Subdivision, Lol No.. Zip Cr •I
t. I)WNI:Ik SI en KIN 1A-)I I..b
ISllet I al 1(oulc NO.) ���
711 GiP-��1L�7 �s1C
OR an I..Cn Sil..� /^ Zip Code
IF .)---_ LI_I-4--- C7aCC
Atbhea
,Ahru code I'hwm nnmhcr
. OAlll DIi11.1.1 1) 1'/' 3
5. I I) I Al . DEP 1 II: __ 7.-Zc25
(. DOES WIiI.I. Rlil'I.ACI', EXISTING WELL? YES ❑ NO V
7 SIAll('\\I/M tI.IiA'I!I.I)clowTopofCasing: 5'00 FT.
1 Rice "+" if Abovetop of Casing)
R 'I I )I' (W CASING IS / _ RT. Above I :md Sutfnee•
• I op of c:nlul lcrndnand nl/or below I1oal torture require, 11
, alianrr In orcordm'cr P1111 I5A NCAC 2(.7
/f /
"III) l fpin)• / ¢u4p-7 MET I101) or TEST
/�-
111 AA'Allllt 7.ONES (depth): -
Tupllgra 'c/Lan(I selling
❑Ridge .lope OValley Dfla1
(check npproprinle hash
Latitude/longitude of well localion
I lcglccsln1inuics/acconds1
L:Ililudc/Inngiludc soulcc:OGPSIJTopograpllic map
(check boa
NH' T11 DRILLING LOG
Flo n 'fo Formation Description
7 — LOLL_ SG- 4-'i r
II. DISINI.1i("IION:Iyhc CALR/^'c Amount l .0
12 ('ASI N(i: Wall Thickness
I)cptllo Di:nncicr or Wcighl/11. NI Orin!
11in11 0 in ,j' I _ se�' ),I
1111111 I.11.
I loom Tn H.
II ( HMO I`. I)cpili Nlatclial i
1 ihnll —77.0_ ll1 18.7 F L Cu«7.ZJ5
14 S('Itfl:N: Ocplh Dianlcicr SIu1 Size
in. in
Il tun 'I'11 I I.
I win To II in i1L —
15 SANIItt iltAVEI.I'A( K_
Dcplh Sic Mille, ial
I win 1b 1)1.
1111111 IO f1.
IG RLNIARKS:
Pvc_
Method
V Match),
LOCATION $KETCI1
Show direclion and dislancc in miles from al least
two Stale Roads or County Roads. Inclut cjhe road
limbos and common road names.
,,t_b rNfN
E Di
L$ttluttiA 1hr-nl-igival to till) Divi
1
I6ifi.l'Iu1hCN 0114711
IIS WPI.I, WAS CONSlltl IC I I'D IN ACCORDANCE \VI III I SA NCAC 2C, 1VEL1.
NI) TI IAT A11COPY 0 ' IIIIS REC.( CD HAS MEN PROVIDED 10 THE WELL OWNER
IGNATl7RE OF 1'IEItSON CONS I RIJCT.ING 11IP. WI11.1. DAl li
ion of Water Quality, Groundwater Scclloli, 1636 Mall Scrslce Center - Raleigh, NC
ZZI, wlllllit 31) dny . CM -I ItEV. 11712001

Addles: 23 f(entttea hit it
2'1uIL/ lSn cr�ul Ilonlc- tla) 9
Li', a ,nlaic zip ('odrr
\ Protndr 1'h.nlr nombrl
NA II, 11RII.I.1.1) 31g.-03
s. I n! AI. DEPTn: 7Q5 '
6 1)(IPS 1\111.1. I(I'I'I. A('E I1XISIING WIi1.12 YES ❑ NO LN
7. S I AI I(\('Al 1:12 I.IiVEI. Iiclow'rop of Casing' _YO Y 171 .
(Ilse ..,., it Abavc Top 01 (-acing)
g I ( )I' 01. CASING IS / P1 Above Land Surface*
.1 Op of r,nlug Ire mitt n1/nr helm• Imul {III Ince require.
,:nivovr In ncnndaucr «IIII ISA N('AC 2('
WELL CONSTRUCTION ItECO1tU 272241
Nit', III ('al mina - i)cpal linen( of Environment and Natural Reso
/u�rce
s - Division of Wader Quality - Groundwaler Section
\)l l 1. 1'(IN 1 It.0 Init (INDIVIDUAL) NAME/ �(p�rinn� 2f9✓I�.D l . ,' IC{</N 4)p'J Cen rl Ftcn rt0Nd�7y��,r�-�
r) I I I. I'ON'I In( IOU CO\I I'ANy' NAME _ Q i'._l�C, L:111) iV <( PHONE 11 1+A5)(]37 R`'t{�
S I A I I. n l l I. ( (INS I Tiff l ION Pt:1tilrl q ASSOC',VI t:n )v12 Prat@III
1 it applicable)(ir applicable)
I. V, i I I. NSF (Check Applicable 13ox): licsidenlial l7 Nlmlicipal/Public 0 Indust;ial (J Agricullulal ❑
Nollilan illl2 U Recut cry ❑ l Ica( Pump Water Inj cclion ❑ Other IJ If Other, List Use
2 \\ 11 1.1 (10A 11()N.
Ncnlcsl than (nai ky
1-iagv1PTH.-Lb iti
".nrr1 uoinc NunJals. (',nulnupily. Solidi
Courtly goAPe
» gs/M-nQ.t kd
Lol No. Zip Cadel
il)ogiapllic/Land selling
idge DSIuj'c OVnllcy ❑hlal
Irhark arlroplialc ho<1
atitu(Ie/IangiIude of \Veil localiou
(degree</nli'111 s/sccoad<)
Lai inldc!longiludc sourcel7(i1'SO topographic map
(check kw)
DRILLING LOG
Formation Description
Rib_✓
SLs4 i� �—
s�-
UEI'111
1'Imn fo
(fix I- i - 0_Q3 / 6-
0. l II:I I) I11i1i ). ?u4RT MF,l1IOD or TEST"
I(I \VAIEli LI)NES(deptll):
LOCATION SKIS] CI
II I P("llt )N'. T ype(.hhoei . Amount _ J_ 1 t 1, Show Wu celion and dislatice in mites rronuit Ieirsl
12 CASING Wall Thickness Iwo Sine Roads or County Roads. Incttiq CCb the toad
UepIL Oiler
or Wcighl/lI. Nlalerial
11,Im O 7 - j yz ).i kiLC.
I hull rn Lt.
1 o 111.
11 GltONI Depth Nlulninl Method
I win �In '.ZQ_-I:
I will ?O— 1h1 , ( I -
Id. S(Tt 1.Er1'. NtIlh l)ialncicr SIul Size
NUR',
I 1win Io It in. in.
I non To 1 1. in. in.
IS. `;ANI)/I ii ,VA'I I_ PACK:
Depth Size Nlnlct ial
11nnt to H.
I nrin Ill I.I.
In. PINIARKS.
D1 11'l' ] c I I -fy I�
Ilfl`1I6Vt( IIli IIJ= 1 I)A�(
arr'I ffr
✓( L
1. et/7r 5 9 ✓lfrt'Y
isrf
minding and common load names. —13
I I IIS \VI'I,I, WAS CUNSlltll( I I'I I IN ACCORDAN('L \VI I II I5A NCAC 2C, WELL
AND"IIIAfACO'YOF1IIIS11PrORDIIA, I(110NI'ItOVIDEI) I() IIIEWELL OWNER
3-IS—o3
SIGNATURE OF 1' tl(SON CI IIJSI RUc11N(; 11111. WI11,1.
DM I
L Submit Mt Id in'll Ili io. Ili isinn of l\'titer Quality, GI moults alcr Seclion, 1616 Mall Scr)ire Crnlrr • ItalrIgh, NC
1221, n llllin 11) days. (iW-I REV. 117/21)01
7(PI'l1.1( ttl Plunie_Nn tit ,IF t i t

272131
WELL CONSTRUCTION RECORL'
NotIh Cmuliva - Dcpaltwcul of Ravllonmcul and Naiulnl Itenotllcc - Ioii of Vnlcr Quality - Oio udwnlir iricA Se elion
red C
11\'IUUAI)NAnli 11` 1»—cr11 rl%1�
\\ELL CON I IUC"I tat NN t NAME,
II �� N �r morn.: B ELL Curt I I AUI Olt COMPANY NANIE ASSO CIAI ill R•12 ;tam!'"
SIA1E \r El.I, curls IIIUC110N rEltl1111 --- Iln,rlicnb
lc
iI n , dicnblc
I. \VRLI. USI (Check Applicable Pilaf: Ilesidrnlinl l�hiunicipalll'uhfie U Indu:111rd LI Agticullutal U
pluuihniug U Ifecoveiy U Ileal Pump \Vnlct Infection U Oilier LI If Oilier, List Use
'fopogtnpllic/I.mid netting
UllIJge LISlnpa LIV-ollcy Ulla(
(check nppngo tar hen)
Latitude/longitude of well location
Lntiludd!r „ohnle souice:Ut1P511 I' (yogi nphic Join
(check box)
L11'L' Lll UI_lll.l.l!JU 1 t),U
ruination pesciipliun
1'iom .I-u
2. W nest.' CA1-IUN: County
IM csll olrn'. d \I -- -
.ECLC. -
- - Ily. Sandivinlnn, l..d tin., 71p Cixle)
1. UWNFRA_ar1-_ti —
Addless _moo t3,1,1'Barke�� ----
(Street or /rude I101
Z1p Code
It loon SInIe
c. u -
Airn rrvlr- i'hoor nn.rber
I RI'I'I Al N 1 \I .I II1,! 1y�:1 1 1 - ES Li I'IU li
5. 1U1ATPhi' 1ii._9.0_5 ' --
6. NUNS IC WELL . •. `r�___I' f.
1. 5I-Al \VATGR LGV h.L I/lcl(t`l 1t�p lrlltAbovlehrp of Grinrt)
CASINO IS 1--- I I. Above I.nod Sullitce'
P. I l\I' ill" C --- --
• 1 rp rl r. J,q n, mL, and .Ire, Lrlon bind nor l•tr terrain •
minute In itrrnhinr nlle Is,\ NUAC IC 01111. ita.
O. YII;LN(Hil)'-�75_—HllIII000Ie1ESfj}71L—
IU. WA till LOIN) S (depth): _ _
y,
11. Nlsltll NCI II214: 1)pcAmount :0
}]i -.F - 12. CASINO:
wall Ihick(cse
Itrplll Uimorier or WclghuIL IInlrtinl
Ilon
licit _lo Ii. — --
I1, (JRUUnlnleennl 1: Ihpllt n rfl�
I'nnn—/2— Tit_,QC2L 11
floe, *1 it_ It
Uimueict
nom_-1.. _ PI._
I o.-- --- IT_ in.
Ilonl_-- '-
15. SAN17/IURAVPI.I'ACK: Sire
I)rplll
Mont_ 1 it _ 11._--
hum--lo 11.
2 I I6.111!..t�
S 'Lc!) [ tl 'V 'r ', i
Ibl1IIPRFI1Ycry' 1'
cuNS1, ICIIUNS!VI
Slut Sirc 6lnteilal
in. _—
lu.
Alnleilnl
!(52 a12S
c•.0
-J
LUCALION SRN CII .n
Show direction nttd dialmlce In Miles Flom ni fcssl
Iwn Stale Ronda or County Ronda. Include the toed
Itnil th cis rind common road names.
IIAf 11115 WI'I 1, \VAS CONS I IIUCIHU IIJ ACCORDANCE WI 111 ISA IICAC 2C, WVNLI.NER
AIt1)S, NJU 111A f A COPY Up'l I Il5 RECORD IIAS UCUN I'ItwVIUL'U 10111C WELL OW
SIUWOE
IIAI UIllt. UP PERSONCUNS 1IlUCl INU'I 1IU W ULL
GRCUNDWP S01HN
ASNr\9 I_ 0;I he Ultl\Inn nl Waterljunlllp, Crnaitdrrnter Secllou, 16)6 Mill Service CU\4ri It(;VRU11Weiht 1 )nl
I76ao-1636 flamer No. (9 9)111-1121, Isllhln 3D tlnys.

272130
1171;LL CUNS11(UC'1'1UN 1UJUUI J1
CFRur ICAI luri r itai /
tluilli Cmoli in - UcpaIUnalt of Eiivhuullicllt null Unload Itesumc� - U{i Lslu) ;oi Water
Quality - UlouuJv��a¢¢l7�cppr,,SeelluC2^ I
IS F.LI.CUN IIUCI UII IINIrh %'hI AId NAME WOO) tAn� rvotl P- r ISL.g-L !
\�
writ, cur' IIIACIU11CUAIrANT•NAME 1 ASSIICIAI P,li ter)PVRPIIU ._
rllnlIin i(n I IlicnLI'
S to lE tvrl.6ln &fi RCtILNr -
lc
iln�dialllr
1. WELL lPSli ICIrrk Applicable lh.x): Reeiticllllnl 1�'°luuiclpnl/t'ublic U iuu,:7.'^n1 LI Agl{cullntal U
Manila; log U Itccovciy LI I Ic: I Pump \Vntcr Injection LI Oilier U If Ullicr, List Use
'Follow nphit/I,nnd selling
Li -Ridge F.ISlnpc IIValley Ullal
(chuck nl.rlrgnl.ie Inn)
Lnliludellmlgitude of well location
A735 ON;23_7,Weld j7s9/
lilrgtnJtolo,11,..‘hrcetirlq
Lntilu.,'al•,ueilude,ouice:UleC'S i1 Olinglqpiiicin
Pig tll l)il11.L11J(i I,10
Prole To ore olio 1 llcscliplion
2. n'I!I"I. 1UCA11011:
CounlyfaE
1M eL�_l 1�,tn vy" .A)
y1 _ InSnhdi vi.inn, l!�1 ilnr 71p Cr•Ir)
'Stier Home, Ilumbn., , i.
3. U\vWplt 1C�GCL.
Add'c55
(Shierl tit Poole Ila)
city p, 1,01
Stott
71' Code
t,
Ain c dr. rin.ne'slit!
. d. NAI II, UItILLPN — a_a-
5. lU1A1.PEE ii1_Slyi- ---"�ut\yl:))7 tiESU ilU
6. DUES 1VIII.LRlil'LACLEXIGIL - ��JQ__I'I.
7. S fAl IC NA1 Gil LEVEL I1clot' 3''!'' vitlAhnvr h r rt Colloid
l VI' Uf CASINO 1S _ )_-- _.-__ 1: f. Above Lmul Sul l'nee•
A. ii.• •
•
ep rl r..Lq 1.�n�b�J.,l.I rmb ru Led.abee rtqu
n
,oilitiu iiliP(,.rand.i,ce„hhlt'MEIl1UUVi^IEsI.I/ tL —`
o. VIPI It (rill!): _�ii -
LQcA'l IUN SICIUcll --
I11.\VAIPRZVNIS(dcpib):_ -- -
Show direcllon and dialnncc h1 mike Gumw'TIrn51. �o
44 Amount 11 lilloic95 --- Iwo Slnle Ronda at County Ronda. Inc{udc e Iub?1
ll. NISIPIfpCLIlIII- 1)pciYS \tit l lickuca,��
IL CASINO: Uinwclrl tit 1VcighVf 1. Molehill Ur tubas nod common pond unnlc9.
NrplhI � � � � '
I'n,at� ft. moo,' /—
'fn_ It --- —"_ Method � Dow_ Meted,
ll, rip'i 1: Ncplll I1. !l1L: — -- ©�
I10111 Ir' / . ___.__
flan, - II, 11 ..--- Mnlclinl '� �d,
ni-
U' lei Slul Suc
Id. ghnl:):Id -Ir,tirIn. yK Kf5 1-�
tr, PI u1 d
Ilnl"--__— -- - pl— , In. -_
Ilnlo-- io--
15. SANI)IIIRAVI'.I. PACK!giro Mnlcllnl
Ihidl,
fo— fl.
HowEl.
—
---
Pi 'n l o__
16.bi n1AItKs j� \ \vI1LL
111 OI}FRf'H1'ltltiil"iLal�? j 11JU111AIACUI'S'UF!Il'hI''L'CURUIIASUGIIFIII'itUVIULIUl01111?KCLLUWNGII
u1C II
< �colls i Ru�ilor) s rn nI u
�� \ i IUNAI UlU OF I'GRSU11 CUIIS I lWUIIWU'111R wLILL
UAIG
l- Uw-I Ill v. ', FIL
§ubolll the nrtgtirnl In flit ilbi Inn of \Teter 1lunllly, CI umidivnler Section, 1636 Mill Service Center - Itnleigh, NC
LI6n1.16161`Im* imiicic)7...ni,nitlilli311tiny,.
3

272129
WELL Ct1N51 ItUC1'1UN l ECO:Ui
ioil
cA:nnrlcn-nor+A
•_r; wn
Notlh Cnlolina - Ucpstlutcul of liuvhouutcnl mid Molina' Ipe.` mccs - Division of \Vnlct Quality - Utouu wntcr 2�-2�IGi
Ir ELL con IttACiIIItRNIIII'ill ttAl)NAM F, lP'I"0 ; \1 rlluflr, A Ip LJ)(1�
wr.LL. cool MCI U tt CtIPIrANY NAME. /SSIICIATi,n tY+)PF.Rn11IN
s 1A1E%%YI.I, GUNS II+III'IIVN PEIInIIIA--_.— ifolllicablc)
if n''licnblc — -
1. 1VP1 1, USE (Check Applicable Ilan): Ilcsidculinl IU—hI!!t!icipal/I'uulic U Indust'inl LI Agricullutal U
hlouilol iug IL Ilccovcty L J I leal lump Wink' ht)ccllolt Ll ollict U If Other, List Use_
•Itiny; nphidLnuij 1 setting
Ultldge USlopc IU''Vnllcy Mint
(check eppuynl,1. ',nit)
I..nlilutic/luugilude of well Incaliun
y3s.'ol _/S, Lr�S1fl- Q
(arprtet/nJnntrt/r-'..ua, )
LnlitudelioneiluJe soutcc:UUl' it l opoglnphic ot'l!
Icherk Iwo;
I)Iu;_L!1l(J I.4J.0
)> Illll
1'lou, 'Ib fotntalion Ucsaiplion
/D
ac_
2. Av' ELL LOCn110N:
Neroesl-lott'n! � �{
L� ref Snhlividt4Lid I1d,71pcode)
r ipee! name, Nornbru. (
1. OWNER! L]y �/ ��Y�—
Adtllcas P o V y/'_4_5-6-
q (, rc!.• n0A? 1101
Tip coax
city ni to„n Stile
Mrs E fhnnc nn iihrt
i,
d, UA111 U1111,1,1°.IJ_
5. -IVIAl.1111'Lil. ----1,i.t\Vlol_I'! YES Li NO U
6. IiuI:.S wrl.t. l&ll'LALI`. EXI31„ - f f
7. S IAI IC \VATEIt LEVEL llclow Top of ('nsingt _5' D
(lire • 1 If Above lop nl [...h'p)
P-1'. Abnvc Load Sullace'
g. I OP t i CASINO Is 1---n
•
, a• nlr'ntrrIn tart nt'aeitteltil n lll'I ISA NCAC ICnd '.a1111p„r'lnh me
h.,.-r r., tl, OE 'IFS I' /{r IC_—
111. VIA Ell LUNIS (depth): —
County C
ya Amount /�--
11. I)ISINI'I'CI ION: Lypc6} pit e WA1hirko
ue+s
12. CASINU: Depth Uininelrr or Wright/IL hlnlel�inl
rtanl (i It _tai- l
f nntt— l ate-- 11-�'-"-__ --
Dow_ lo--hL—" --- Method
1 II hlnlclinI13.
To - __ F.
-_- hlnlu inl
PC!!'_ _- IJininelct Slut Site
IA. SCREEN: Ucplll In.
To I`L_i i. -
hnut I — — il, In.
Io_ ---11.
15. SANIN3111AVIII, PACK: Site hlnlnlnl
Ucrllt
Lit 1't. _
Mont
.to
U IIOUI-: luh or h1..PL/[
Ilom�—.I.�—
Ilom
16. I3Iih1ARKS:
iir(rIn' 3gIlff1'\
A l Ul',110#1 S IrI l
L
IIucnl IUf1_SK)SJSII
Show direction nod distnIicc Iu miles Guut nt lens!
Iwo Stale Rands of County hinds. Include the rind
nuiiibeis nod coitnlmlt rend nnutcs.
I
/721474 y
111115 WL'1.1. WAS CULLS I Rue' EU 111 ACCUIIUN ICL' WI III I5A IICAC 7C, WELL
)S, ANU I I IA f A COPY ur I I IIS RECORD IIAS REED PROVIDED 10111E WELL OWNER
LE
_ _ - uAt E
SIUNAIUIll1 UP 1'6 SUil CUt451RUCIINOIIIE WIILL
l)wrI REV. h,NC
Sn{,i }�L•-�1 S arJglnnl In Ihr �Ilchlnn el Wider Quality, Cr nunJ,rnler Section, 1636 Mill Service Center - IOEV. Ia NC010001
11f E A@1L)�ur No'.I9191111-)111, within 711 dnys.

272123
WELL CONSTRUCTION RECORD
Not III ("nlolio:1 - Itepallmcnt of Environment and Natural
'I/tes}nnutecs - Division of Water Quality - Groundwater Section
k%III.( UN l l tdl Wit rn(INIDI\lIDUAL.) NANIF. rrinp 1)MV F._//1 C. e.3.4JO'v CF,ItTIFICATION N ul%1I
\\ r I I ( UNIT? .\( IOR (u\N'ANS NAME. %( tQp©k e 14c9e [I :ARi 111":9 PHONE tr jryr%,r 1337--SCtS"
SI.\II- \\ l:11.( O NS I Itl'("I ION I'EI tlT0 ASSU('IA1 RI) WO I'FItNII 1k
(it applicable) (ifapplicable)
I. 111f1 1. IISE (('heck Applicable (lox): Resideulial 11Y Municipal/Public ❑ Inuusnial ❑ Agricultural ❑
Mnuiinl log ❑ Itccmcry CI Ilea( Pump Water Injection LI Other ❑ IIt Uher, List Use
2_ AA'F.I. 1. 1 ( ('/A1l)N'
Nearest Iorvlr /1161 t/ CountyCJ;Qrio
4)/'k/27A-25_cn-e-e Z"c2 I SS IOwNJlI
Si an N:mne. Numbcw. I'eammairy, Subtivisinn, Int No.. Zip Cole).
1. U\1NI12:
r\dilless W/td<r Ci / 41.) )
ISImet I um Rolle No.)
Mt.t.<0.4y NC_ 01706
t-ill er 1 rma Stole Zip Code
bT - 837 -- 305 7
Anea code flume number
1. 1)A1Ii!)Ittl,IId) 3.-2 0:3
Tollogl leirie Land selling
Midge lHSlerpe CIValley Orbit
(check appmpt rote hot
I .;((dude/lougilude of well location
I lcgreemainweskeeem1s )
1 atir le/Iungilude source:(il'SCITopographic map
(check Ear)
DRILLING LOU
Formation Dcscrip1 ion
Pet) Ce-st
I) II' I1 I
Form to
. 101 AL. DI.I'"Ill: ?CS_
J 5
6 I)OI!S \\'111.1. RUN Atli TXISI INC; WELL? YES ❑ 14(3 6' 1a�.` n5
7. SI-A1I(\VA1F.12I.1:N1:I•Below Top ofCasing: COS. 11'.
Illse"+"Ir Above lop or Cnsinl,)
R 11 )1' OF CASING IS ( _ FT. Above Land Surface'
• Imp ill castor! lerr nlmalnl illor Edon hurl snrlare renanen m
•:n lance 1, nrrnnl:Hue alb ISA NCAC 2C AIM
YI11.1)(plpo) _--MEI110DOFTIST
11) AA -A 1 I it 70NES (depth):
/el t
I1. DISINIII(•I111N:21ypc�.JloCiaiX4 Amount__.(_( (c/.')
17. CASING: Wall"fhickucss
Depth Di;iiielcr or Weight/fl. platcrial
Irmo _ © To (20 fl.�jY n s1R2.1 1>VC._
Front Tn II.
11
I •I
I loin To I'1
(;RO111 Depth---- Material Method
I unn Q Tn }) FI. Cz"leten- r e
roru,.'a-O_ Ill/ ZU _ I�I__l/_
N ZYJCI-� S-�+I�!/�
•RI l'N: Depth Diameter lot Sim c llalcn
I tow la It.
I t ml Tu 121.
IS. SANDDI(i RAVE(. I'A(K:
D plh
I Coln to rl.
I loin Tn II.
in.
I I2IIMAI2KS.
g IpF iiriLgl�i"(j7R1I 1
LS(1'rpDSl b@I(' 1()
Size Material
LOCAL ION SKElC11 r
Show direction and dislanee in miles fron%at Iensf
Iwo Slade (toads or County Roads. Includc)Illc u)ad
numbers and common road names. —'
C0
..1272
-V;
I Ills WE.I.I. WAS CONS I RH I(• I I'.I) IN ACt-OItDANCI'. WI III I SA NCAC 2C. WEL1.
, AND IIIAI.ACOPY DE'III1SPf1ORDJLt?krL
FEN PROVIDED IDIIIEWELL OWNER
—�a1):1-c1—c ,L1, hey �3 � -one
SIGNATIIRI? Ur 1'IIltS(N CONS 1 RuCIING 11111. WEI.I.
DAl Il.
Submit 1 +H.I re Di 151n II of \fader Quality, Gruundn tiler Secliuit, I63(I Mall Stoke Crnler - Raleigh, NC
agmo tiraVCIW,#4 (!pi 733
ASH:VILLE RE�'I' i L
1221, nitIlin JO dayt. GW-I ItEV. 117/2001

273492
1VELL CONSTRUCTION RECORD
III.. III (:nrlina - I)(-p:alm(ul of ISnvironnlcnt and NaltuaaI II2er:ru cts - Di'v'iss lion of \Vnler Quality - Groundwater Section
�i ii-110, 7 _`E. t . R o5 CrItl 11-1CA I ION M 3E3 C
numIII,'III\(7(n1('II\II'.%N\' NANII':_...RQs--.1,0911---Pt 11 l'-y _.--11'2)_y.2—ys.73/
__ I'll(IN F, p
s1 \II \\I IIv,1 Oil 'I-II(IN I'r:ItIII1 if _,._-_ _______ _.: _..!\SSI)CI\'I f'. II%NI) lit IIMI IN
I il:J'I'1 able) —__._____-.__. lip npldu able)
\\ I 1 1 1 IN I It \I IOU lrvnl\'IUU,U.I NAME (Intern
.1
7
VI I I I Hsi; (( be(l• Applicable Box).. Residential IAV plunicipal/I'ulllic Cl Imblsllial 0 Agticullural 0
tvI, alhni imp 1.1 Rcl l nety ❑ Ilea( Puny' AWucr Injection Ed Other O If (Item, I.isl I lsc
VAIII In('A III /Yr�
r-�, :II iICI Ir,R ll: /1Uf Omni)) C` _
�,/oe-1^)es i . LURC-h. �A — -.- -- -
H,nnr Nn:nh�.:c l r•r:rmvnill'- Sub111Akion. I,ul Nu_ Zip Code;
I I \\'I'll'I)
'Soe kbens_s_ -_ k-
Arl,h, c,: /5.5 . GespQe-Tr' - - _ -
I CO3rl n Il nine rill
All Ue4ev;Ile) 6-11Code
S'IQGI
I licrr I,,,o 'Moo
TnpographiciLand selling'���)♦!'h/
I lit Mite I ISlope OVallcy L11
h htrk appngnialc hn,)
I :liludtAoupilude of well localion
id. .pn e,,nrinnlrc4t[umk)
I,nlinnbrlrny'inulr corn cc:I(ilSO Topographic map
(dlrvk Lur1
I)RILLINU LOG
l'ofnad ion Ocscr ipl inn
�'+4Te
Olt I II
tip Pain In
'Psi-. 952 -o5r ©)—ma'
-
I1(11'4 \VE1.1. 121''1'I Al 1! I'XISI1N(I \VE1.1.7 YES ❑ NO 1
SI;\II('1\A I EIt I.f.\'f1. Below Top of Casing: _SOD _I' --
it ice "1" Above 1 np of ('nclnrl
X. I ()I' (IP (,\SINt 7 is I /_ _ P-I-. Above I,:ind Sw fare'
I ,•p .,I redid. Ice udn:rlr,I :oho hrlom InnA Milne, rtgnatt •
r:ninnrt ter nr rrrrd:vu'/r vllh I5-\ NrAU )('.I111A.
'). V11.1I)Ippul) .. i3. NIEtlIUDOF"II:S
nl AA;A 1 r. it iuNrs nleplil):
Ar, • r,•d..1.1,„rmnumber Joe'_SOO/
).\ 11' I11(1111:I) S--oZ
I(11A I.DE1'I II.
I O('A IIUN SI<ETCI1
I UI :I rdf (I I ION 'I cI n'L%1�AR)^?e_ Antolini 1 L(p) Show ditcclinn and distance in miles linen al leashq,,
I., l',\sIN(i wailIIiickncss Y Iwo Slalc Roads rn ('auuly Itnads. Includc6c ti,
?Mill
win .Q to /DC it.
see.�a __P✓c._
non fu fl.
.,—
arirl
It (I11111I O,-plb NIatc1i:11 NpIl,,nI ��
I I,lll 0. 1 n U Il _n rrt
�'E rLe�Z y��R�a✓17 e
1 um'do in 1co 1.1 Cuyntif -yµHvr p-
1 1 V 11I IJ I h rill l)i:nnclrr Inl Sipe U Nntrr ;d
lnnl Ile I1. in. in.
nnm Ile I1. it, in.
I SA in) '(IRAvi i I'At'I;
O, pill Sir Maki ial
11.111
1lnn
to Itl t.i:Ali1
I�v-� II�(PI 1t, Ic./U 11fp1' inn
nc, (IrtI:IU14•1 p INS IANI)iAR�
I IIIS IWASCONSI IN A('('l)RIIAN(I: \\'I I I I I5A MCA('
)'I IIAT A ('(li`)' 01' 11111S Itii('11ItI 11ASS ItI'N I'ItOVll)F1'I U 1l11r \VI I.I.O\VNEIt
Ili AI lilt I', lif l'f.ItSUN('ONSIltlll'TIN(i.l I III\\'II1.
---So3
I)A I li
I krill IT under III 1\'cighVft. Mak1i:J nunlhcic and cmnnurn load names. W
Snbnlif Ilir-o, ipiulililm Ihl I!i\ isinu u( \Valet Qualify, Commingles Serlion, Ibl6 NI:,il Service ('rider- It:deigh, Nl'
!TWO 11.11.I'brrncNo. lgpa)?/3li 1,nilllin 31)da\s. (i\V-I Rli1'.117/2111)1

273491
1VELL CONSTRUCTION RECORD
Nul1h I .:,(,(1(,,,, • I h•parmcnl (I htivitotti 0.•IIt and Withal ILsolaces - Diiv-iission(14 Wain- ( )u:Jily - Uruundwalcr Section p/
((�� (Ale
_._W• P.msE _.- CEIt 11E1CAA 1111NR 3 sic(:,,
n1II IlhNtlt\( I tlt('IIMPANV NAnIF-__PoSelS_(Ale' I_.--_hRii 11U�___ _ ____,-_PIIIINE Mlva il42 J-17 I
51 lit \\ I -I. I I ISS I IkI I I l(N Ph:IINII IN ASSOVI \lTI) \\ f) PEIIMI I II
(il ;ggdirablc) (il npplil.ahic)
\\ 111 (('N ilt \I'1111t IIV llt'lnn,\I,) NANII': (alloy
1 \\ Ill . I ISP (('heck Applicable Ilex): Resideulinl I11 Municipal/Public LI Indushin! ❑ Agricultural ❑
Nllnliana hie 1.1 Rccmely ❑ Ileal Pump \V aler Injection Li Hiller 1.1 II (tabu, I.isi Ilse
WI'I I. I (u'A I I(IN
Nr,ucq Inns //7 IF
Grittily titter k,-e
I-(01_voeS$ - CttLRc _ R.D
rot ..n Maur. Nn:::1:rI<-I1':tinny. Sanditi<ioo. I Di Nn., lip Code)
I (\vBrit
\I l:lll'cs
1.5.5 CaR&rr-:LLt /— -
(Shoo ui Itonlr Nu 1
�11►1 th6e✓I11�° G-A _
th,I LI1rmo SI;,le L ) hip rode
AFC) ,.:J:. naa:Lrl
NAI I MI) I i l - 9- 9,3_--
ODES \\'P.I.I. IZI..I'I.ALF, Ex's.ilN(i \'I'LL? VhS [A[JU RV."
1 -
7 ': [A I IC \ViVI hat I,FV I -I. 1)clow Top ([Casing: O --it
((lac "I" if Ahoy lop Of 0161n9 .---_
I II' (IF ('ASINt; IS / h-r. Above Land Sutlace•
• I„p „t nWup Ira odo:mct) twat hrino' total torfnte regolra Ia
. al hate In ncrnrlm¢r %IIIh 15,\ NUM'IC .01IN.
'). }Am ll(ppm) _.5..._..NihFIION � OF /1�
1n \ye\ 1 I It /ONI S ldcpll q: _---_a�� ' tiL
I 1 III<:RJII'( I It NJ: -I ypcG'IL ,QA Q__ Ammo(
llgln['r;ll)Ilic/Land selling
1 Wider. LISInpc DValley a1
it lir, k ti ppngtriale hml
aliluddlungiludc of vcll 1(cali(n
I It rter<'atinuIt-phec'anJ<I
I ;Ililud1. 1.1101adc sow cc:0(il'S�Iopugrlphie m:q1
(check bin I
I)RILIA NU LUG
Formation I)cscl iplion
12 (;\SING Wall lhickncss
IIIIII
1,1111 In Il.
writ -_.. I to I -I.
I Ir1'all I)i;unrlcr ml \\'eight/PI. I IaI:uinl
0_ _ i I' . /Q l n.._G 4 Shad_ p V.c _.
11 I WI II I I 1). loll. hl:llrlial Method
I .0 -I„ L) _ i t _..0Q?e^?7_.. tall ki11—y/_
lam Da In/O ( 1'1 CurnW5 --
11 `:I' PI I-rJ 11:-1'Ih Ihntiteler Ina Sac Nlatrtial
tutu In II. iu. in.
Hutt I to I t. in iu,
\I111 GR.\\'I-I I'I\( I.
I), pill Site NI:urtial
Into In 1'I.
I lnot I( I1.
In IN NI AU
1'10 I POI 111I( fJ,�1' it (1
/-(4(,(II tih I CI, NI 11;
b
IDLI'111
I'nun 1„
0'-to) . Se C 5j G--
.66c1'
LO(. Al ION SKI:I C•I I
Show dilrclitnl and Ilisiai,cc III miles Farm 11l Icasl
Iwo %lc Roads tor flintily Roads. Include the road
iitii, dc15 Intl common Fond names.
I S \\'rl.I. WAS (()NS IIti IC hill) IN A( ('ORI)AN('I; WI I I I I5A NUM: 2l •, will.
1 In I A (OI'Y (jr ItiIS ItIi(ORN IIA.S RI'r[J I'ROvIOrl) if l III; 1V1'I.I, O\VNi it
I I IItE OF I'EltSON CONS I ItI I('1 IN1I I l ir. \\'I'I.I. 1)Al
Sulmmil the n1 ipinal 1n Illr-l)i( ICI 111 II[ \C;Ilet' OIl;llll(', (il'uttnil\rMet Section, It11( Nlall Srnice (roam- Italell;h NC
27o'l'I Il:lo I'hmmn Nil. ('Flit) 71.1 1221, Is ilhin ill do1 s. (l1V-1 ItFV, 117/21)111

273490
1VELL CONSTRUCTION IRI;COItI)
NoI Ih 1 ;u Mina - tiepin Ilncnl of IuIvirounlen( nod Nalurnl Ressnuices - Ilivvisiun ul \Vnler Quality - (irouudwaler Secliofl
\,III I(IN I II \( lIn11A1.1 NAMp. (pr11.1)_—._TA[tlE.S__ O.. .ROSE C:EIt'IIFlCLA'l IC/N M.7 JScj
\\111 rIINlIt \('IuR 1I II'.1N1' NAI\1V. p,o,4o'LI
s U._,L .'KII,LL �i-1'IIONF. NfI liya- 'j3
SI \11- 1\lII_((J\S 11111 IruN PlAtN1II11 ASSOCC\'Irli' l)I'rlIn111M
l it appiit able 1 (II nitric. lhle)
I \\'I I I.IISi it lirch Applicable IA)x): Residential Vionicipal/Pnhlic ❑ Inllnsnial CI Agiicuhurrl O
NLmilnliuv I_i Recovery I i I Ica) 11nnq) Water Injection ❑ OIIi r fl IF( Mint 1 isl IIse
2 \\'III 1 f 1('A 11(lf4 I'
"'me',hero "1.4RP _ _h._ County VLEf I'.
_ (t.-)eltuIr.R_
,n��c Nnnlla�l.. (n �f h�. CubJi ciao
1'la-rl r: i, let No. lip ('Irlrl
or i ;V ipl is/Land selling
[III ige [11,5ifitc ❑Valley ❑1:1;11
(check appinprialc host
:ll ilwle'lonpiintle of well IOCallrlll
, 1 ,\\ IlI-It' A.7 cc}�_ _, `€4 O Id.•r 1 n ukJacond ,
AIIJI _.3 y7,1j lSLoitas.✓1j(e__N-A-? __ lalihub lnurihnlr soon \.O(il'SofopuRoy,hic map
n^ I I I r 1 Ipnn No l � /' / khnk hall
Lvi(t 4C,_ _-.a &I in IIIIi DRILLING LOG
1 )`011111 II Stale /ip(.Ie __- from 1,1 nu Mallon l)cscrip(inn
b 1W37-50 ._- __._ ©�qq'-'3ol S pc CntSrNC',-
4n�.i.Jv rlvan-nllniho� _33'- ',so' ___ F14.4..-)_t_
I mug. Nur! fu 5-7-013
s I(1t At. 1)F I' li '
r. NI )1 S \\'I I I. Itl.l'I A('I[ RXISI IN ; 1V171.1:/ YP.S (J NO E — - -
7 SI A III' 11' A I i It 1 1' \' P.I. I lelow -Fop of Facing: 0 1r1'.
(I I<C"1"Ir AII(1VC lop ofCnclnpl
S 1 (11' 1ll ('ASINI J IS _ I_ FT- Above kind Surface' -- - - -
11..p of (:icing ill olio:0.11 Mho brinw Imwl sot/rite regliIrre •
A:11111f le. OMIT ollh 15.\NC'A(' 1('. MI IR.
n VIIII Infiniti). O _ NIP:IIIOI)(Pi EST flit _
lu AV-AII It /UNITS Idr1tl1: 1
175'^- I-T iH--.---_-_- R()('ATION SKLICll
I I Ill-.11111 1 III iJ 1\pc CI\ OC Amount Shaw llinrclion and disnulcc in miles lion) al Icasl
LS)FZ I �_-�Y� Iwo Stnlc Roads or Comb' Ituads. Iiicludc Ilic road
I. 1';\`;ING \\'all'IUicknccs
Urplh U/i-nnIcler or Weight/ft hllalrlial uumbuis :old continuo road names.
I anti O_. 11' .30 l (...K7»» SDR2I PVC
11,1n I t) I -I.
I inn, Ill I I.
13 ( NMI i 1 I )lrplh hI )dial Y ^htribnd
1 win O 1,, 30 _ fl ce e 1-_. _- �I_�f�l,
11I1I I1 v_-I I1 II -_. / ___
11 Sl 1'I I.N 14'plli I)iamcicr Slot Size NI:Ifci ial
I Hon 1 I1 II in in.
I n1111 111 I i in. - in.
Is 5.Arii),( ),,AA'I'I ',ALL,
I )boll) Sic Nlalcrial
I tom In II.
I Ilan In I1.
to ItI-N:\RI:S.
II i' i Ir r'
T.
i Ith IP(I IIIIN SI r\fl
0
w
tip
rlI IIITS WI.I.I WAS('ONSIlttIl' I ID INAC'CORI)ANCI: WI I II I5A N('A('2C WI:I.I.
t IDS, ANN- IAF A COPY OFTlIi ItI 1IRO IIAS 1111{NI`RU\'llfll) It) (III'. WELL O\VNIIt i
I I IRI'. OI' PERSON CONS 11111('t IN(i'11111 \\'f I.I.
DA 1 I'.
z
0
0
r1
0
0
a Sn)ianll,.ifo•lor$Orpd, i"I° IIc I)i, ision of \Valor ()wilily, Grnundw:ler Section, 11i16 NIaH Se/ \Jre critic! - Raleigh, Nt
27ho') Ida l)irlrv;n. F,Iplfj'j_ 11 1221,ttilkill )Il IInt. (iA1'•I 11 V.(17/N)11

273489
WELL CONSTRUCTION IIECOItU
Non h Cmmina - Ocparin)enl of Environment and Natural Reso1u
/rces - Division of Wnler Quality - Groundwater Section O
)c CLI. CUNIIt Af IU1t(INI)IVIII)AI.) NAME (prluq w)��4,,-rL'V f�05E CERTIFICATION dagp
w I. I.I.('NN' IIUr 1011 ((mtI'ANY NAME— ROSerS 4lJF'1 LZIlt(et�q PIWNF a eAn Hy,. 34/3/
SIAM: WELL (UNs i RUC" I'kalall"I N ASSUCIATFI) WI) Pi:AntI In
'if npplirdrlc) (if applicable)
I. \VI'I.I. I ISIN (Check Applicable Box): Residential lid" liudcipal/public ❑ Industrial ❑ Agricultural 0
hlnnilulinf O Rccocciy ❑ Ileat Pump Water lujccliun ❑ Other ❑ II'Olhcr, Lisl Use
2. \Vfl.l.1 OC'AIION
Neal csl l own s'l) i.4-Is..5
R4&9 ER%
1511cr1 rl:nne. Noolkfm. Innniuni(y, Subdivision, Lot No., Zip ('ode)
t. ( AA'NIf12
Allies
S.Sa-O-No Y ..s_�_ s
.5WO 0r Moore Na.) 1
1
AI (kap
l llv„r In a C1, r Zip Cade
Awn roily I'hnne moahrr
.1. 1/A„'. DIRI1.1.1iI) 5—fa-03
5. ILITAI. I)EI'l 1I: 11100_r
6. DOES \WELT. RNFLACE EXISTING WELL? YES ❑ NO Qr
/�)
'fopngraphic/I acid setting
���
County Gle e-- DRidgc OSlopc Malley INflat
Icheck npprrgnialc 1100
I.ul ilude/longitude of well local ion
I rleprecs/mit des/cecoudsl
I.atihuic/longitude Sourec:U(,I'SL7Topographic map
(check host
DEP 1-1I DRILLING LOG
Iron) To r
r-6,
7. S IA11C WA'l Fit I.(WEL. Below Top of Casing: /.20 FT.
(Use "✓' if Ahuve Top urCnsli,g)
8. "I OP OF CASING IS / FT Above Land Surface•
op of r.,drrp Irr roloalyd nl/nr below Inud sarfnce requires r '
, arlaote hl ucrnrdnnre sslllr I5A NCAC 2C .0118.
o. YIN D Omni): MEl'I IUD GE TEST 1C LE_ __-
tn. \VAIFit /ONESIdcp111): 285 )— /S (rP
IL I)ISINIIICT
12 CASING:
I lumI0
I HMI .10 1r1.
I IOW --.rl _-_--- 11.
11. (iI2O111I)cplh /�Nlatcnril
111,111
To
I nml2C1_ fa 6 3_ II. Ckrai.1
Id. S('IPEEN' Depth Diaolcicr 'to' Sill!
tom Tn __-- El.
1 tom
I5. SANI)IOI2AVf.l.I'A( K:
Ucplh Size
I non I I'I.
I lam Tn I:I.
11, REMARKS:
in.
Malcrial
ION: .1Y1,c
(,A. LtIRW C_Arnouul
Wall Thickness
Dinh 7 Diaoicicr or Weight/FI. Malcrial
To6J H. G !4'r fl2 2I PY_C
Method
Anv_ i'.hdcl is
Formation Description
se r CAsri G-
S'L-.I?-TLgr
LOCATION SKETCI I
Show dilcclion and distance in miles from al least
Iwo Slalc Roads or Comfy Roads. Include the road;
uund,cl s and common road names. 0 0
W n
h a_ iE R
we67
11115 \VE1.1. WAS UONSTiiili "I Y1) IN ACCOIRDAN('F. Wl I11 15A NCAC 2C. WELL
AND 'fIIA1IA COI'Y or •l IBS P CORD IIAS 1311I'IN PROVIDED TO IE WELL OWNER
S—/z-o 3
SIGNATURE 0 - ItSON ((lNJ 'I ItUC'I !NU l III? \Vlil,l.
DATE
1.r7rr'IRTE (ti Ig119IFllle Di isinn of 'Water Quality, Groundwater Section, 16,16 Mall See%ice Coder - Raleigh, NC
27f49if'l LholLNi) PM) 7113221,withill 311days. OW -I REV.117/2001

273488
WELL CONSTRUCTION RECORD
Nnilh C;uol inn - I renalIntent of Environment and NatuTral,,RcSouiccs - iDivision of \Vinci (duality - Groundwater Section,/
ninn /11,,J--N]/) br�,,F I r) rC 1I^)NO A) CE1tTIFICA I ION II r)7 II
J RD!'(v'e: -tad} DR1 `'1rjq PHONE N I$7g1R7— (.)
ASSOc!Al 1(11 \%Q 1'E.ItI\I`111?
(ifnpplicablr)
11.l. (IIN'I It \(I Mt (IN'nl\'In11A l,1 NAME
I I ( It\( -(flat ('ll\il'AN)' NAME
.titII \\ I;i.I. (Ir\SI I(l'('I ION I'11011l#
(if applicable)
1. \\ I I I. USN Applicable Box): Residential Municipal/Public O Industrial ❑ Agricultural O
Mnn'uolroad ❑ Rccovcry ❑ Ilea! Pump Walcr Iujeclinn O Olhcr O If (Ilia. I-isl }se
VA'fI I. I( )('A (ION'.
Ni;ucsl 1 yiw�'i ttfdlspLv __County eke -keg
Non, Maui eic I immunity. Subdivision. lot No.. Zip C'ndel
Addles!:
i,tic l ,-E ke iivis
Q hax i n z-
ICmn
rUnitamcNn ' &%QO
n l (.u1 1ti?. a
iivo I!P n Cain Zip Code
I )-. __73 S - %' 22
,Ica ctnlr Plume nonibai
OA I P, Mtn 1. lib 'f-30-0
I1 Al_ DEl'"I IL 3n S )
DOER WIiIJ. REI'I.ACli I :XIS"TING WELL? YES ❑ NO IJY
S I Al I( \VAI LIt l.EVEl. nclow'lop of Casing: TO El
(Ilse "1' if Above Top of Casing)
l of' Of CASING IS / F'f. Above Land Surface'
• top of rashic lrnndnaicil al/or bclusy lunI snrfnte rtyolrts •
nn Eno In nrrordnnce n lilt ISA N('Af TC .01IB.
1"If.I.I) It'pn1): Q__- MEII IOI Of TESL'
\\'A1 ail? JA)NPS (depth):
I I ISINI I ('I ION --I via' CUr:2NQ_ Antolini / CLIP
('ASI N(i: Wall 'thickness
Depth Divncicr or Wcighl/I I. NIalcrial
rZ
Ilona 0 Tu 1 © I n EDiar ibnj PrL._
I ran 10 FI.
1 ram l 0 EI.
Il. (;Ru)(IIl Depth Niatcrinl Method
Iran 0 Io..,2Q El. CerV_-•)7 MOOT
1iuma_a0 _10 9"1 EI. CLI71j_ RA✓2 .jI
1.1 S(Ir
k m CN_ Depth Uiacicr Iut Si;e Nlalrt ill
I Will lb 11 ill
in. _-.—
trm fo
15 SAND(( i'AVI'I I'A('K.
I)c1dh Sizc Mnlcrial
to E1.
I o 11.
1 ml1
1 ion
a -
3 IJ C
r 1n r 111 ruin' l'IR'I
(I)tJSll?tl( IR)NSI
jl'apngrapliic/Land selling
I_ urge ❑Slope [Walley [Mat
(chock appntpn inlc bona
I :ditudc/Iungiiuce of well location
I de gt vcr'mhnla rt'«ctonls )
I .alilonlc/Iongiludc source:Li(il'SOropograpllic m:ql
(check he))
1)_El' I II DItILLING LOU
Horn 'Iri Formation Description
'-9l' C1.y
GIN 1 E"
LOCATION SKETCII
Show direction and distance in miles from al (cast
Iwo Slalc Roads or County (toads. Include lire road
uumnccIs and common road names.
ek.Ll o
p el N RwDt
—4e4A20r DO
o�
rr.°
in
rn
rn r
rn
-r
G
2
e4 •p_DRM
1 1111S WELL WAS CONS I ltll('11.I) IN ACCOItDANLI(WI I II I5A NCAC 2C, IVELI.
DS. ANDDD I ltA1' A COPY 01111IS PIT ORD 11AS III'nN I'R(IVINIiI) 10111E WELL OWNER
SIGNA'I our, or I'PJtSO (' )Ni l RUCIING I I In Wlil.l. UA71>
. l-30 -03
F r Sribisit(Ih( orignr Jf. to the Division of Water Qnallly, Grdundlrider Section, I b)b Mali Scr'Ice Crntcr - Raleigh, NC
)7h1r') ThTbf'Tma(' Nu, 7)) 1221, odlhin 311 days. (iW-I It E.V. 07/2Dnl

t.
274036
WELL CONSTRUCTION RECORD
Din Ih (':Indian - I )corn anent of Environment and NaturalltuaRcsowi-cs- Division1of \Valet Quality - Groundwater Section) ,
t ,111 1Il lit.\( NM (INDIVIDUAL) NAPII'. /((p�rrin�l) � h1 '�-J-I�' F�1MG-Yl:,J tJ U�) crarrlrlcA)LION �Z / /p
NiI I I. t I NN) lt.\t IUIt( U41'ANY NAnIE �1'Ie16.15 U_J€?)-I I ��i IIis_)7 PHONE a fICA V37-OO
SI \ II XI III I. (' DNS IIt('("I ION ITIIMI'IM ASS(1CIA'1 El) 1t'OITIu\IIIP
(ira plicable) (if applicable!
1 1V1 I.I. I6r (Check Applicable !lox): Itcsidcnlial lA Municipal/I'ulrlic ❑ bulbs lial ❑ Agricultutal ❑
Mount,' iag CI Rccntcry ❑ I leaf I'utup Water Injection ❑ Other ❑ If (Thor, List Ilse
\\'IlI I.I.O1';\I-ION- �
Nt.alcsl i "tn Ai p / Couuly�-hleg-‘,1/GH_v-
Ti eeL. & b eft stg_el er) eVe Lori 3
I'.In vl Nana. N!imbu s, i 1�nnnunily, �/�S11l1111vilitm. Lnl No.. Zip ('tale)
myrtrit-
Adnctcs
ISnn, Rowe No fL 3araq
c1RT" /'�a Q0aiaie
l -ilr,r TimmSI{dr / Zip('011e
l d(OI-_... r G D ^Jr.5 LI7
aide I'Inme number
I. 1)A I I' RII.L1:1) U
13l(a
Roo aq 1 �R e TtL
1(yogi: iJLanti setting
❑Ridge I..Inpe ['Valley ❑Elul
I nccrk aplanprt3Ic lint
I aliltide/longitude of well localion
;
9.11)1At. DI'.I'lll: c 5r _Ji
(,. Iimp;\\'1'I-1. KNIT Ark EXIS1INC WELL? YES ElNO 1117 _ (70
7. SI r\ll(' \VAIIiR 1.1:VIi1, llclow -rot) of Casing: ,7J_FT. )-, p_.2)S
(Use " t•• If Aoove lop of Lacing)/„
S 1I )1' or ('ASINt i IS / FT. Above Land Surface'
•I tip nl racing lei mlinnrtl *Um orlow Into] sur(are rrqulrer •
m bore In ntrnnIm,rr a Ina I5A NUM' )Calla,
,I \ Irl a (rhino: __/,,S' —. hn:TDUD OF TEST
III \VAIIiR /ONIiS (depth): �,$_5 ' /%Q '
T
I I. I IISINI'F('1 ION: 1 \pc,L aJ.-u:i- Ananud _QQ-Q%
1' CASING. \Va11 IIiicknc.q
leplli Di;lnicler ar 1Vcightlhl. NIalcrial
I11111_-_D 111 YO rl. d 111Q 2/ _P
I Him To
1 Trim -1 o
(;Itt )I11. Urplh /�M�atclial PIccl6ud
how (9 .1II a,5 Ft. c n_ T-[' Artve c
1!lin, r �_ In 90 1�1 Ca,714 )%%!4 iT
S( I' ITN Urplh Di;,'elcr 'Slot Size✓ p1:Ite,.
15
Illan 1a II. in
I into Tn Fl. in
SAND'GltAvr.I_ PACK:
Site
I
1 14,111
Urplll
In
Io
1 I N11111 P.pll'i 1'YIt'I If 11'I
(()NCI UII('lll)ll Sl ANT)
Mai er inn
1 • Irgrccyminnrca/scunulc )
Laliludc!hmgiludc snlllec'.❑O('S❑Topographic rn:q,
(clock hm)
Uljl'111 DRILLING LOG
Flom l o Pannalion Ucs`rip(ion
S— L ✓e;
(QQ l—
c) (J'n
10I"T
all
CD
(J
LOCATION $KETCII c-
Shaw dirrrlinu and disinter in miles rrom at GcI
two state Roads fit County (Roads. Include the toad ; 2
nun)hcls :end mammon mad names. '
I1IIS \VpI,I. WAS (ONS I IOW II l) IN ACCORDANCE. \VI 111
I) 111 1 A CUT' OI''I111S RI CORD IIAS 111:1.N ('PUN/II
SIc;NAIUI r.UI I'T:RSUN('ONSIntl ICtING l In \VI II.
ISA NCA(' 2(', WELT.
)I) TU T11E RPI,I. OWNER
6-2 -0)
DAtli
c II , Lh _LCr10N
q�I Su,hilkilH'durili:S�IinGfd't6�h' I) vision of %Vatcr Quality, GI'utmdnater Section, i636 plait Seri Ire Leiner- Itnlvlgli, NC
27(1) !fit() Plane No. (11t1)) 1. 3.1221, is hhlu 31) days.
(i\v-I REV.1)7/2(11)1

WELL CONSTRUCTION RECORD
I Ilnlh .nnlinn -
Ng II 11u\1t1A1 I /' 1 '��r�
11111 (11\ 11111'11)111 (,\II'AN'\ NAND"__-.l .L(?LZvkee_ �1 �.-I L"t ll1'V� --. -_,•
!:I III nitt r(1\sIItl'1' I ION M I11%111/I _ASSOIL\1PI)\\I)I'I.I;NIIN
Ill a' 1ic'Icl (if akplicablc)
)cp: tion of ul Elivirotnncul and Natural Itcsamccs - Division of \\'alrt Quality -
lit nn'nn'IuoIAI.'NAME prtolp_ cjL tesk- _N__ YJ [tk.,Ru
274035
Urnuudn'alcr Sccliun
CFIFI IFICAIION N ,S11%3
IIONF. N )�,'3r 19j,�1--�'cYl�
U 1 1 I O';I; I(-Ilrck Applicable !lox): Kesidculial /t`lunicipal/Pnhlic LI Indu•:n ial ❑ Agricullmal ❑
7Jrnihn ilor ❑ Rucn,cly ❑ Heal I'uuq, Wale; Injection ❑ Ulllct U II( Miel, List 1Is(-
VA' 1 1 1 I r l l 'tA I (��
11 .,n :1 I n,ln 'lit-H' 'L.L _--_ _ ( ou111yS..-!_kgiL9��-�'.
us Bee Leo1'.1P--I r::::m.. 1111:':I.., 1 o:mnmuly. Subdiviann, I o�o. . 7 i' hotel
O \v r i l e f.06o__R l7 Cop0,3 unue.f _
.A'IIi ----; .5ye 7 LAB: k\\-} CruR Y
IU r p.m,.I )
Lut.s L r Gla p� I _FL is 335:7 H
I$1.3, %9`/ : 22
1 OI Al HIT 111: '-C\_5..
1, I ,I IIIS \\III I. RI[I`I.A('P. Ir.IS-IIN(i WIi1.1:7 SITS Ll NO ET
I AI I( \\'AI PIt I.I.\Id. Itclulc Top nl (sing'Cl-I 1.
Ice "1- Alu,vc lop 1'I 1 bdngl
1111' O1 I'ASIN(i IS Pl-_ Abnvc !mini Siil:t c'
• r.IJoe 1r' minal r'I Writ beton Icon <urlare trqulr (Pi •
ui:nur III nrrn.,mark ni11, Is,\ N('A(' tC .III IR. �7
V11 1 1) Ippulp / 7 _. MI' -I IION UI- I ES I. Ei/
r
111 \l,\II'.It/I)111.S111vpllll _-_ /$(_) aQO -..
I III'<II11-f( I IOIl 1 yp
1.' 1 \ `•INI1
1)rplL
1n /.S I
/l
l,�t�QfZIU E- Ann,uul—._ �..Cil/J._
\Vnlllhickncss
Diameter nr Wright/la r•Iulrl ial
fn11---. -_-- ----- --
II It(1)111 P1.11C11111 bl.Ibo'I
C) 11 �i ) Ig.vtPa 1 Y_
O 11 151 l �Ijy
Irnll
1 NTH,
to
Vt11 t'1 iRAA'I' I. I'AI I
I ,cull,
I win - 1 n
In
1 Rain
I'1 C—t1m1-yS _ %-+ivl
1hu .ntlu . SI uSl . in FI 1
1I in in.
1 1 in.
I\
; l l)rrrII( 1111N S1 ANr,AI1
LJ
NI:Ilcl lift
ft p' iaphic/Land selling
I: Ii idpc L !Slope [Walley Likilal
c4 nl`I`nq,u tlr Inn)
1 aliIII I - Iongiludr of Nell locdiou
(.I..prrrr'In ni leckn:lank)
I ;Mimi&'I ' ngilndc sourt c Ui )l'SLJ l upogr;lllic neap
(rbr<Ia bnr)
1)I1 111 DItILLING I VU
plum r I n , fnlnl•dinu Ucsciiplion
C -- /_5 / .. SC i C451^-1C7—
W
r_
--- llkA-LION SK:L'icll
Sh , v IIi1111inn and diclancc in miles frnnl at Ira!
hvo Slab Road,: nr 1'nnuly If rinds Include the roatFg
1111IIII'rl': :a 1111 rnnlnlnn load Rattle
n
W
49)
I MIS WI'I.I. WAS ('ONS I Ilnr I PI) IN A('('nit1 \rl(I \c1111 I SA N('n(' 2(. WELI.
, AN1ym}\ I- A COPY t)P 1I IIS IM4C1 /IF,Z1I/\i: jj1'1 I'Pn\IDI D In l ltl! \vI Ill) \l'NE.P.
III'\\1'l I. DAZE
RR6Y
11
'FItSUN 1.'( INS I RI I( -I IN(
Sulni,ii Ian OIl ni r`i'!c ll( 1) I ision or AA'aler IJualllk, (;i, lnulnnlcr Scelinn• 1611 1\bill Sri ire (cntcr - Ilnlrlph, N('
2'b'rl 11 1t I11 h rv7. 1'llT1iTl 1221, n ilhin 11) days. (iW-I IUTV, 117/21101

WELL CONSTRUCTION RIECOKI) 273917
much ('onllina - Department or Environment and Natural Resources - mr Division \Valcr Qualify - Groundwater Section
\\CCI 1 I'1 It. iOlt(INII\-11111AI.) NAME (prinl) 1L-13) rE� JLttt7.17Q/'.) _ CF.IITIFICA I ION /DI/
)Nil.1. (fIN l It\(' Wit (O'II' AN). NAME Ciejlo e�. 4Je II ball 1014? PHONE 11(136) —goe)O
SI Ali \rl(I. 1. ((INSl RUC ION 11E11511.1P ASSOC:IA'I El1 WC) 11l01ljk
lifapplicnbk) (II applicable)
1. U'rl.I. I ISF (('Meek Applicable Box): Itesidenlial I M1Ilinicipal/Public O Industrial ❑ Agticullural ❑
Mnlilming IT Itccnceiy O Ilcal Pump Willer Injection ❑ Other O II Other. 1_isl Use
2. \VI11.I. 1.( I.1()N:
NJcalcsl Mown'. 4i I4 - L. County C/toto Kee_
I A,rrl Nnnm. Nunibel<, ('4 hVnunily, Suh.Iivislau. Col No., lip Code)
1 O\\'Nlilt'. Galt.
Addles._ 7Q7 V=
(Suet1 el Itnul No.)
4mn iI4t Cry- 3,9,9 l
1 ilc a,y5 n SI.IIe Zip Cbtic
(77o)- Yocc- `l/ia
A...., •,,ae phom• munhci
.t mil:, DRII.I.NO 5-7'-03
5 TOFAI. Dli1'1'l1: tQ.s r
6 DOTS WELL ItFi'I,ACIE EXISTING WELL? YES CI NO
7 S'I All(' \VA I NIt LEVIiI. Below "lop or Casing: 75- _TT.
.
(Ilse "4" if Above 'kip of Ca<ingl
R l UI' Or ('ASINC i IS _ / FT. Above Laud Surface"
• I yip of raring trtmioalyd nl/nr below land eurfnte requlree •
,,u lance h, nrcordn rr aln, 15,\ NCA(' )C .al IR.
9 1'IPI.DIppnit__3..___ _METIIODOFTEST lei iQ
In A1'A hilt 7.0NNS (dcplli):
L
-tgmgrul)hic/Land
Lt} Wgselling
c CiSlopc OVallcy ❑Plat
Ichttk apptepr ialc hen)
1.:11i t udc/Iongi l udc of well local io n
I Ic Freer tn, i ((III C sfsecondr)
l.aliluddlungiIudc somee:1_1GPSO f(rpographic nmp
(check hotl
UIiP I I I DItILLING LOG
Hein 'I n Ponnatiun Dcscri Mon
— i / ‹)i1/
II. 1)ISINITC1.11)N: Type CkLaJ2_he_ Amount __(_pup
12. l',ASIN(i: Wall Thickness
DepthDim Icicr or Wcighl/rt. M1hticlial
rl�llllO )/a IT ', s-AQ7i &v(
I tow To IT
Ilnul To Fl
I. I IROI11`:�j'� Depth Nlaictial Method
l tnln__V— To_ " 0_ Ft, ____ _ r!iVI(Y
I Iot1 2.-L)In //O Ft �'l-ITT1�dS �Q-6'f2+�/
I•I Sl'RI I N: Ircplh Uimncicr lal Sire JJJ M1laki injj///
I Iran( To It. in. in.
rim II .fn rl. in, in. _ _
15. SAND/GRAVFI. I'A( K:
Depth Size Material
I oot To IT
1 lalll To I1.
I6. REMARKS
i
)III",11)',,()N lil(I�J1�11 �111
)NS I Ill I( I TUN Sl)\NU \R, ,�
Gd_
N
LOCATION SKE CII v
>0
Show dilcclion and 1lislancc in Miles From attieastf„'
two Slily Roads or County (toads. Include fo: .r21
CFI :Z.IIIIIIIbc(S null common road imilicS. N nts
cn
G MPC cPeEk ,e\p
WELT, WAS CONS'( IUJ(' I I111 IN ACCORDANCE WI 111 1 5A NCAC 2C, \VELL
D II IAT A COPY 01'1fJ/IJcJ1SI11l'URD 1 S BEEN ' tUVll)I'.D TO "HIE WELL OWNER
•
5--7—D�
SR ATUIW OF PERSON TUNS I RIR, I IN(11I IF. \VI7.1. DAlli
Ilillnijl�hy. rtl));iinij Ib�'11cl,l�ivfsin t of \Staler Quallly, Ground n uler Section, 1636 Mall Sees Ice Cotter - Raleigh, NC
rr''f•'(J(PhirtitNi1;(')t+))-7;,-, ,nllhln31ldays. tiW-I ItEV.117/2001

273915
WELL CONS'1'ltUC J ION 1{ECOitll
Iin, d, t Olin, I lc p;uI t uhl of Environment and Natural Resources - Division of Water Quality - Groundwater Section
/
t\tIt «nvI it at loll(INDIVIDUAL) NAME WI) ')41/Ib 'tF �C,k 1 3/ rob oto CERTIFICATION /�)'4, 1
'I11I t (I\?It\( II)It CO\IIAN\.NAIIF. s.-%)J �'� lIO2.11 DR�k It'V'9 PRONE M JIM)CZ ^B�y
S t \ 11'. „I-.t.I, ( DNS l ltt'1'I ION 1'EIt Il I N ASSOC-TA" F.1) \(l) PF.Itntt i II
ail applicable) (if applicable)
I WI.I I. 11SE (Cheek Applicable (lox): Itcsidcntial'[31' M1luhicipal/l'uhlic 0 Industrial 0 Agricullural 0
t`Ioniha jog ❑ I(cc co cry ❑ Ilea( Pump Water Injection ❑ Ocher ❑ IF( inter, List Use
?. mitt or AIION
.
Ncncsl too r114RP 1/
Courtly
t? RNeeL .JI a7
ton rl Non,. Nnndbc,c. 1mmolanily. Subdivision. Lnt No.. Zip Codel
O\\'NFR
A d,hcss
/1''I u P y KC - �$
ilym Irmo cads 7.Ip ('ode hem To
Ape) rude flume nmuhr, `�
L UAiEi)RI1.IFD 3-/5-o3
5. 'WI Al. DITI.1I: 717 '
6. U1)PS 1\'I[I.I. IOl1'I.ACE EXISTING WELL? YES CJ NO
7. S IAll('. \VA"I NIt I.EVIiI, llclow Top ul'Casiug: %S
-I (I)l ap -Maud selling
I.:IRidge 1 ope [Walley ❑Flat
(check army/Mate hnsl
Latitude/longitude of well location
-Yoe 2€I)/�� 'y, /N�e_uico43
_55 1 k)0 sr • 1-I / Lntitudelougiludc sootcc:❑OI'S❑Topographic map
Snot or ILnac No) (shack has)
Dlil'III DRILLINGLOU
Formation Description
PeJ Cry
7 r� - 7�7 S'Lg"TE
Oise "I" 1 r Above Top or Coe ina l
S 1111' OF ('ASIN(7 IS / FT. Above Land Solr ce'
•I i�p id mean, Irrmh,nlyd el/nr brinsv 1nad mrfnce requires •
hurt h, nrt, rdnute •, lal I5A NCAC 2C AI IN.
1'IPI.D(hpo11�_-.1 y7�._.MI NIODOPTEST
Itt \\'A 11(R 7.ONIiS (dcp1lt):
II. PISINII ('111)N I)-p,• l hLOQIA_) . Atttollllt_
12. 1' \S RN(i Wall (hick yeas
Drpih D�ianl'ter or Weight/Et.
I tom -_d _ Ill _2Q_ FI. trf %N StaiZ �1
Flom Tn Fl.
1 ,, III ----- in Ft.
Il (iR01 II` Utpd, Alatcrinl
I win _.0____ Q__ .1 o__ O _ It. �n'1P9 1
hunt 1 o Ft.
Id 9'RI' Fri 0111h Dimncle! Slol Siva Atalrli:d
InInl 10 11. in. ill.
Il1,ln I n Fl. ill. In.
Is SAiND/(;RAVE'.I'A('K'
1 rill Sbe Material
I nun In -.. It.
nun lo II.
ET.
lo. PFAI,\I(I S:
u/y. __ Show ditcrtiun and distance in miles From agasl
--/ Iwo SLdc Roads or County (toads. Include the roa
Matcl ial mmmbri s :uul common road names.
pv(- _
Method
Ik II II1j1 I 11 Iif
Irgtceominul rs lsetaods)
a
LOCATION SKETCII ,c rn
ti
I I IIS WEI.I. WAS CONS I lUJ('l EI) IN ACCORDANCE WI III ISA NCAC 2C, WEL1.
S, ANDND 111�Y Oh'I I IhC I?I!CI )RD 1�1;1IV PROVIDED )1 O �11IL'. WELL OWNER
(L" 11 .-- S-is-03
SI( iNA I URR OF I'1. RSON
'ONS) ROC I'IN(i'I IIF. \VFI,I. DATE
'Won of 11'nler Qt ,Illy, Ground's der Section, 1636 Mall Seralce Coder - Raleigh, NC
I-3221, within )O days.' GW-I ltEV. 07/2U(11
(3:Th71"!h1CMthllig,,Ilbl I the 1
ASF f2JA'PE IRbphICltMh 17%5EICB"I 71

273914
WELL CONSTRICTION RECORD
Noiib ('andiun - 1)cpnrinlc it of Environment nod Natural Ikcsi uteesCDivviission or Wald ()wilily - Groundwater Section
a r.1. 1 (i/Nrn.\UI UR IINUIS'iD11A1.) NAME AIM) brit/lb,r•,41c_k[w1 I'
0�`) CERTIFIC`AtlON s iJ
will 1 IIN't It WWII (-I)'II'AN1• NAME l / le R"n�W_��� lr �_Prlj` PHONE N [o%is) -%"0G008
S I A I I. WI I I. ('1 ENSinn lib's: I'4:11M1IN I I ASSOtIAI EI) wQ I'r.Ra ITp
(ifapplicablc) (ifapplicable)
I. WIT I. IJSI, (Check Applicable Box): Residential H"Mitukipal/b'oblic ❑ Industrial 0 Agricultural ❑
Monitoring ❑ Rcco try ❑ I leal Pump Water Injection ❑ Other ❑ 1f C)Ihcr, List Usc
�. WHI. L(Iit
Nfl'. u.. Ck/ 1 e.
nllesl rnw' MCourtly �o
I tinrci N:nno. Nnnan•i s, ( 'oitiluniry. Subdivision, Lot No.. Zip Cadet
1 l)\VNIIIt: y�QLLN _"SAL' t ..ITL: Idegreeagninuleslsecnuda
Address l .5 TnIzFAeJEs%. LtJQ - " ]R Luliludellongibulc sotnce:❑OPSOTopographic map
(Snot or Rowe No.)
/UiL( ►may 7!tic_ agio_co_
ile ai In II S iic Zip(kle
()- '335'-3613
A' :'rode I'honr uun'hr:
1. DATE I)RILI.PD .S-- 1)—(73
5. 101 Al. DEPTH: 707
6 I)r)fS \\'I(I.I. RNI'LACE (EXISTING \VI?LL7 YES ❑ NO (I
7. S I Al 1C \\'ATNlt l,I[VEL.. Odom, Top of Cnsiug: r2i QQ_FT.
(Use "s•' If Above Top of Casing)
g 'I rut or l'ASIN(i IS / Fr. Above Land Surface",
• I up nr (nclog Icrmhnied al/or below Iaud surface require'''
'ai lams h' nrrardeu e s Ilh 15A NCAC 2C .01111.
Q. Y IP.I.1)I mill). 2 ML?JI lOD OF TEST 11/P.
IU. WAVER /GNUS (leplh):
"ropogiaphic/LatiAcksbiling
❑Ridge C1Slopc WV -alley ❑Plat
(check nproprialc box)
Latitude/longitude of well location
ULI'fll
1:10111 1 it
DRILLING LOG
Formation Description
—70J
rn
it
IJ c,,,
LOCATION SIETCII De
I I. N ISI NI F.(`I1GN'. -1 ypealagare Amount Show diruclion and dislancc in miles from avast
12. CASING: Wall Thickness Iwo Slate (toads or County (toads. Include IRS toach=
Depth
D/ii''aa�nl�cllcr or Wcighl/II. Material numbers and common road names_ , y
Fnmr a To 73 PI. at I/6n 312 -1 _PVC ��.r{`� o
(Milli To it.
1 win To IT
13 IiR0111I)epih Aimerial Method
1' tort'_ rC_'to a Q It. C(o?'% T_ 4)VITy
I ii,lii _. 0 1 n 9 3 - It. CMt is vt-rf _
hi co l(I.Fry Depth Diameter lna Sin Ni:,it,i:
Imm I n 1:1. in. in.
I'10111 I 1'I. in. in.
15. SAND/( ;PAVE.L PACK:
I)eplli Sizc Material
linty 'lo It
no,, l n IT
16. RI:NIARICS:
kkv
NFTrl
. u iik:II IJ I. A
i I1•1IIS WELL WAS CONS TItt)l`I;I(I) IN ACCORDANCE WI III I5A NC
DS, AND'I111AT A COP T OF 11u5ItECO RD I lAS Rr °N PROVIDED10
e+t
SIGNATURE OF I'EI{SO 'IINSlIt[1CUING .1111, WEL.l.
AC 2C. WELL
'l'I1E WELL OWNER
Submit Illy at iCinal a the
GRG F„Erolt4$i3T it ekt TIR'NCE('11'))
Jivisloi of \Paler Qutdlly, Gruunllnuter Scelloo, 1636 NEW Scrrlcc
t i_)221, Wllhin 10 days`
Center - Raleigh, NC
(i1V-1 REV.07/21)01

I
I r,t,;l I:
275'732
\\'ELL CONSTIttil I ION RECORD
'd,•IrI,n,bl„I I It1,:nnnrld „I I iivinnnncnt and N:umld Itrenur'rs • DR isi„n I,I V,:11,r l)mdily - GnnnuItyntcr Sculion
() G
r\11I rrr�IPr f IInI(I\nl\ lnlrlll NAN11': tit; 1.0) 1) L. \)l��'��� ('Fit I IFICAI ION fi
rtI I1 Irr'.lIt\( IUIt(I rtl1'. tN'\'N,\MVI � heitokcci_ &Uee/ ppiI//r'I') IIIONF:n (Fa)1 it u11,Iii..(1•I
z1 tl l 111:11 (u\' IIlI r nr)N I I ltn1114 _— \SSIII'i\II11 ''(111 Ii \lion
i I (il np1, i1 ,Ilrb: )
P. I I I 1:•;I. I(hrcf rAIgdirahlc flux). Rcsidudiul Ft}' hluniripal/I'uhlir I 1 Induvn ial LI A)tliadlmnl U
f_I„nihnin" ❑ trL n, r1) I] Ileal Pump Water Injection I 1 Olhcr 17 II I llln,l, 11'1 I Icy
',III IIn :AIII IDI p r
:,I rsl Ivrcu i7j r��l) L-l� ('alully-_ ./LehO
•rJlln,h-I-.Suh livi(inn, Inl Nn, Zip ('nJrl
['t t3n =r 37
I:rI. t .,t !tutor Nit
ti7lP-bLiti. tryC- Y��ICS
I I 1 •,uI : rr lip l 'ode
r, I r�'-Sir j 3:77 /.)C;5
:I I/A 111 I IP II. I. I'.11 Q.:--7-S.-U �7
II'I \I 1)1111111.
Ill rl : \tI-1 I II1111I ,\rI[ p_s(ISI INf; 11P.1.1:7 \ IIS U Nr) I I' ---
I.; I A I \\'AII'll I F\'El. I IcIow Iipaf('nsing:__,_j(:I .I1.
Il kr"I"ifAhm,r l,q, nl ('mint„
I I II' (if I ;\CIN(, I t 11 Above Land SulBore'
tl
In
II
I'
'I•q 1,.-arq, 0'010,0,0 nIhrl I Imnl tint brr ,,1uhri•
n intur I n.rnrll,n(I nlllr IS,\ N( ,\1' i(-.OIIN.
111-I I lrlmll._..%7-- MI•, III(/l)OI' INS 7)l� _ .-..
t\ .\ I I'.I', „MI' S II II I,ll1). __._ ..
Nr.INI I.( -I ri INI';I,(L\i,o1-2.34(' A lttminl/Veltev•••
R'all 16icknc.c
b'hIh �.IJia\rn/ctr or \l'ciglrlil 1. r.l,nclial ..). I n iU.. I�L�i)_Y> „ .5Qp,_ .-.
at . I ✓C. _
I I'm
I n nI
II. I1.
I n I
u.1t6 hl I lid pl tl ,.I
11 .,h_) IL ('Ote")i..._ �F2A✓rl--✓
Ir I
II I, Idb l)i.nnrlrr sin! :iro GLpIi:rl
In
11r
PAA l-I 11.0 L
I r,InII Si7r
Ir,
I r, 11.
II n
- I I iu.
Ni rlrr i:tl
{ !tog' r l ivL;unl selling
I:fi1!id1 r I Isla re L I\'allt•y ❑l-I;ii
tr 1,..r1 apPL•p, i,nr hn.1
1 :rli lnJc'longitude Vl. rct'II lucnlian
3%I • ('LDS. /V/ _L,6 (A--)
I :II ilullr h,I l iiwli"-r rnrt ISriii'S❑hopapmpLic nlap
fleck I,:01
In I' I I I ultit.LJrJ(i Lou
flint . I I, I11nI Rion l)cscri rlion
__ �� `. Lt'lh _ 9-uN r L
I(II'A1 n1N SKU I CI I 117'-
Shmt din'r lino and (1 Inner in miles fiat 1 I\ tS
IWo SI:ur I/0:Ir1: r,1 1'omdr Roads. IncludC9hc ip+.IQ'
0) —I
1111111110,q and 1'0111 nn11 road IIalI1eS. (n O
P\L
)t).- /
..�t._4 fir,\'
/110oF'-i- lib
IT,-) iI11I I I1 Ilhlll IlljV IIIIS AA111 AAA'("INS 11,11 IVI/ IN At ( Oltlhl1rI'Vt1111 I',A 14(',1(' 2('. NLI I.
r l.11 14 I I( Ili S I A1!Ir AIr4 ANI) 111' I' A COIrI' O1- 1IIIS IIC4-1 III) IIAS 111'1'tl PP( lA'IUI-I) III I III, WPl.l.IjVVN17t
L
-c �"
N-zu� l:a. ie»a--- zs o3
1 II,A-I let OI I'I:ItSON((ptl:; IItll( IINI;IIII- \kl 11 NAII.
L
Slim nit Ihr t 1 i(niu•i l' lii The I) rision of \\afur (1ualily, (irrllllldtt Met Set lion, l(t( 01:1i1 St site (enlrr - ltalclull, NU
�'Ir(n IL1L Plr„uI NII Ial')) 111.1221, \ci111in 11) days. (i\\I It! \'. 072001

WELL CONSTRUCTION RECORD
275558
NullCarolina : Ocparinlcnl of Envirnntncnl and Natutal licsollrcca - Division of Water Quality - Groundwater Section
1%1.1.1.1 un'lltnclOu (INDIVIDUAL) NAME /(tinp i...MIRfL E' �rleS CERTIFICATION M32y,7
itll.l. I I ON I It t(' inninn(I I\I I'ANl' NAMElktnekee WQu �Q, I II'V I'IIONE N ( 8143 /,-7`p0 C�$
S rnl I: tr cu. (O,\SI Ittl I ION PERMI I'M ASSl1CLYl FA/ ts'1) P , aillp
(if -applicable) lif applicable) ..
\VEI.I. I ISIN (('heck Applicable Box): Rdsir1cnlidl /Municipal/Public O Industrial 0 Agricultural 0
Nlonihniiq Cl kccnccry O Ile t I'uuip Wald- Injection ❑ Other O If Other, 1 isl Usc
2. \V11.1. I UCAIION: /�
Neal tsl 1 'vul PI (AA P) County \.t Qg,
. _.. )1tksQn.iy oRC aCi
Cabral None. Numhcis. t iulniily, Subdivision. Lot No.. Zip Colcl
1 OvvI1Il _PeDb -r
\dines '-7I
ISecl (it Runic N Runic
urzpIif1 ��0i
('itviv I,„,„ salt .
Zip Cole
(c ,% « ,-C130'58
"o crvie Homo number
el 5 I()IA URILLfI:
l.
b. DOES \VIil.i. RUN LACE EXISTING WULI;/ YES O NO CV'
7. S IATI(' WA l ER I.P.b'EL Ilelow Top orCasingt .Sf'z__.h1 .
(Use "r'• if Above Top of e'ncior)
S l Op OI CASING IS / FT. Above Land Sorlacc'
' I op or rasing Irrrol anent .Uur brfuw Is of %orlat! requires IN
,aflame In ntrmdn,re 'I11i I5A NCAC ZC.01 la.
9. 1'IP.LDIMMO:_.-_.3v METHODOFTEST n:,2
Tnlnrgr pliic/Land selling�//
Clltidge USlopc ❑Valley U4Ial
(cheek appraprialc Ion)
I.aliltalc/longilude of well location
I Irg:tcdurinuks/sccoiuI )
I.aliludealungiladc solace:D(11'SOTupographic mall
(check hns)
Ohl' Ill VRILLINO LO(I
Plum Tn Formation Description
O - �'� lYN D rl Ay
�?^ ILLS
10. 1\'Al l?11 ZONES (devil*8S t / 00--1_ _ c-) �-
LUCA'hIUN SKL fCl I co L 0_
I I. NISINI 1'1:'I ION: •Ivpc (JrtL--ofbO€-Amount .1e2OtFltiC Show dircclion and dislnncc in miles froitC� Ictf$^
rile
12. ('ASIN(i' Wall "Ihickncss Iwo Slate Roads or Cotnly Roads. lncludtc tOalL'
1)cptl: Ui,•tm I •r or weighing. (pnlciial uundacu: and common rand names. C...)I (Him C_.. I0�.%' Ft, ,ill.n ¶ JQ PVC
llmnl Tu _ I I. -7-
tWm ll' Fl. _—� O
I 11It(l) 1• Depth Matciinl FAlltIlo I—��(� z•-
I n:ni_.0_ _ I (I )1_ fl.__. tmegf _?/'�!'I"✓!71
I non To PI. ____ _
Id. SI' IIIiIfPI - Depth I)innicler Slot Sizc M:deiial
I mm I-t 1I. in. in.
I mau 1 (1 IA. in. in.
IS .SANI)R RAVIJ.I'A( K:
Depth Sizc Mnictial
11nu1
I Hatt l i
lo. P.I rI,\RI':S:
II I NO II4 �I'I 11Y t'1'It ItI 1A
I,
111115 WF 1. WAS (ONSTI(I I("I FI) IN AC( ORI)AN( i' \\'I III I5A NCAC 2C, WIELI.
)S, AND' II T A COPY 0Ji;11JIS RIfCy){t0IIAS I11:1'IJ PROVIDED 10111E WIWI, O\VNlilt
SI(;NATOR1IOR PERSON CODt$X tt1Cl1NG "I till \\'ELI.
+ts-oT3
DA'I I:
Suhruit 1114.4t.14 l.ta. I Ile
)4'1 L tilt Uiltl.")1; {a Io) 7
is him, ur \Paler Quality, Grouiidaaer SctIlan, Ili)h RI:ill Stalky Crider- Raleigh, NC
i.1221, wllhiu 11) days. (I W-I REV. 07/2001

275557
11'ELL CONSTRUCTION RECORD
!mull, (' :mil., - I),'p,,iimi ul or Environment and Natural Resources - Division of Wain Quality - (iruundwalcr Sectioo�n�`
n 11I ( (rl\ Ili \(-I( lit {INDIVIDUAL) NAME (prh,l)__ R9 / I- _..--'5Qti-c?.S _- _ (TER II I ION <3-+1 I�j
5
U111. 1 N.n.'.\( 11112((1\11'AN1' NAME_ Q_lijj._ ,•__ LOF_1).._- 1II)vq ....- pnuNE Of Jt'gl O7—`dC-t$
SI \II \ \ I I I,( O\S IItI'( I ION PERNII IN ASSOCIA'I Eli WOI'Flt\IIIIt
Iif a)•)dialhk) Or applicable)
I \'. I 1 1. I r; -. t( Inn F Applicable flux): Itcsldential'Municipal/Public O In,hr,n ial [J Agrictllutal ❑
Nnnihnine 1.1 Prc n, r1y ❑ I lend Pump Walcr Injection CI Other 11 11 1 Hhrt I isl Use
_. 1b I'I I 1111 +\III )hl
I') :nrsl 1o,cn ,,,hLC8tk1/ __-_('aunty e,k-ue
Sox 7u12TLcL.MrC
tan, N.nnr Nunlhrn:(,nnumniiy, Subdivislaty. I of No . Zip Code'
„Wrn
\rbhrlr;
Ric14Pb 3e,'ir1.
-- 3 1 \3UCIC_S._TRp!i-__-b?,\VL,
1 S11 r, 1 ,,, Itmr c Nul
tliGoekii
r t / Fur• Zip ('ode 1.",,,,
(`S-3) `535 (l/C,
9n-.1 I 11 i,t' n1 I
ir 1)\II mil 1.PN ( -13�03
Ir)I,v nLRll1 CpC)�i' Jo/ — )5__.
' /
r;. I n q'c \CI,LI. Nil Am:.. PXIs-I1NO WE'LL? t'ES CJ r1V L(v
7 SI+\lU'1l'A1lfRI'.\�I'I. Below Top or Casing: _$(� I�T.
;Ilse "I"if Above Inp of Ca<h1c1
I (11' DI ('ASIN(; iv. �_ IT. Above Land Surface'
' I,q, nl ri<Inp trnninvred al/or brlow Innd .adore require..
1a11an1e In Fin-ma:1 ,, „Itlr 15,\ NCAC 2C AI18.
1'IPI. I)(ppm)- _r) 4))my! lion OI TEST 2)1o.
A I I lit /ONO .S (depll0:
forli ralliic/Land selling
I tills' I:ISlopc [Valley ❑Ilan
(duck nips p inle boll
I :uilude/Iongitudc or\vell location
II I(II/I NII:( {ION:I \ pc._Cllap.I^/__ Amount/OD �` 4^.
2 ('A':I N(is Wall lltickncss ----
Irplh Diamcicr or Wcighl/li. iI:lrlial
1111_ C) - T(. io2 to_ Y_ �t�J _��c.__
t`lalcrial Alclhol
'I._..CLrbieC1..__. -_`J'N-+4✓/7/
' I r/
Diann{., Slut Sirc P lalr,ial
I. in, in
Si)c Maieri:d
II.
El.
Io I'1 ri,\BI,S
I I In 111 P.EIrr (II III l OIL\I
I\n)d'.Ipl It NYiNs 1'ANII{\tl
L,
`1 1 - . - -- i t• Al i• OF PERSON }flsllttlCl!NO IIIP. ACId 1.
Ll �i
Si hmil Ihr, original In Ihr I i -isl rI of \Vale/ ()wilily, l ;roundn'ale( Sccllun, I6l6 Mall St lice writer- Ralrll;h, NC
rip" 11/161'hnorN,11'IJa1' i /22 \cilhlo,llldn)s. (i1V-I RUV.07/21101
1 /Ei' SEC 1JiA
I_ E - OFFICE
l,I•eme<hniunieg <c_ I<I
1 alilurb''I1ulginalc sonicc:UJOI'Sl7ropogr:ylhic nap
(Hurl( b„q
DRILLING LOCI
ic Ia Pnll anion Dauer ptiun
o / J/ C-
A
1.0CA'nION SKETCII
Slinw direction and distance in miles I}nn1 al leas( o
Iwo Slalc Roads et County Roads. Include IG7road
nu%inhcis and common rand names. ,'')
____s_jkoSd_l ✓I
11,7 C u toPP IJ
I I IIS VVIi1.l. WAS CONSTItO('I PD IN ACCORDANCE WI I I I I cA N('A(' 2C, WELL
) AT A COPY OP 'I111/1 fi) ORD IOAS I;IlrJ 1'RRO\'IDI:I) IO 11 IL' WELL O\VNI:It
C/1
DAlE

275238
WELL CONST1tUC'1'ION REC:O1Z11
i
Nrnlh 1 •:nnliim - 1 )cpaNnwul of Environment and Natutal Itctolnces - Division of Water Qualily - Groundwater Section
wilt rnr'lit4( lint lInnIYIUUAI,)NArIr((prlul) 2[Z'i2/I F _:JCONE�cull1rICATIONNa.3a9S
II IICI.I I N'IIf \( Intl( 7)?II'ANV NAME /ZCQ-e_ GC')E)5
II .;Jll %)9 I'IIONE N filAS U37-7(07
SI,\I I.\I rl I.(O SIItUI "I ION PI:10111H ASOUTAlFT/ \SO PENNI Ili
Of appl itahle) (if applicable)
I. VII L Il';li Il hcrl, Applicable Ihx): Itcsldclllial /hlimicipal/Public ❑ Induslli:d ❑ Agricullulal ❑
Noninninit CI Rcnncry IJ Ilea) I'ump Water Injection O Other ❑ If t )lhcr. I"ist Ilse
VIII" I I It 'AA I II)N
N•.rai si (.(nrnffr� ..11L(i1�4\. ('ounly tko
Uh('2SC:-0
col ti KIM(' NunA,crs (''immunity, Sul, Iivision, l_ot No. Zip C'rdc)
,. tIWNI It C- ORyvt__ R6
�� ��llq)ngrnp I f!c/au(I setting
Nl)tidge [7Slopc [Walley ❑I'I:I
!check nqunprinIC lye')
1 ;!)dude/longitude ofwcll locolion
I.1•Kwrv'mimde.keconds1
talitudelongiltille coulee:f.]CII'SO Topographic !nap
(Srl rt i❑ Poole No.) (Ora hm)
A41Ofk �S 'g yob I)II'III PItILLINOIAO
tii' r In + ::I:nr Zip Code flop) r Ib formation Description
Ir �
-54a5 _ _ Cs,R-a�
c)_,
L ,a -•
.
t._
4 it None imstilwt
I I )A IF DRII.LEO_.._... Cz- I I -03
1OI A(. NEI'l11 /
G. IH)1•S \l'I(.1_I. It1il'I Alai l XIS'I'IN(i WIi1-I:2 VIS Ll NDL)i"
7. SIAI l\'AI ER I.Ii\'lit. Below "lop of Casing:
/ (Urr "4" if Above Top of I2a-incl
S '1 t 11' ()Ili CASING IS / FT. Above Land Surlacc'
• Inc ul a:.tIop (crrulnatrd al!ur I,rlme Intel euchre requires el
ar l:unr In nrrnrdmy�rff. Mill ICA N('A(' 2C'.01111.
511.1.1) Igphi) : "_.7 i1i. N11((111OD
Io AA'AI I'.R JONfS Idrplll):
I I D011411 ('1ION:1-elrrc_.l\1it21A)_'_ Antolini_] *.!.f'h
I' 1'ASIN(I Wall'Ihickncsa
Byrd; I)ia yiy icier or Weighs/I'I. '.lAAlc�lint
1 un_._C l oi�_ II.�pfSs aP
I inn l n I'I.
I t 1;Pr It' I PC1101 NlaIt ,nI Nlrllu nl
innr_0_ 1,, ter.-.24 I L CLoAsSt"r %`4,✓I%
I nan fa I1.
1 <r' Rfl'fl. I)rpIL ... I)ia0Wiel SIOI SI)C I.It 1i:l
Wnl 1 PI.
mil I n Il.__._.__in. In.
Is S.rAhill/I RAY:I. I1:11k
1kI•Ilt Sizc Malclinl
I lnm In 1'1
1 ti llr I .
lb 1''I N1 i",11KS
r LLf
Y f�1) 1II Ii�:IIYY''L
Cl q,l'(I I l II I Inn
CO O
O
rn:J
0
LU('AI ION SK:Ercn
Show dilcrtilul and dislancc in miles front al least
Iwo Slalc;loads or ('ounly Itonds. Include Ilic toad
nunlbrl s :11111 r(nn111011 road itaittes.
I Ih\I 1111S WM. WAS ('(INS'! lllIVI ID IN All OltDANC!: \\'I I I I I 5A NCAC 2C. WELL
),1111/S, AND'lll/ht A C'OrV 01111 RIP Olil) IIAS lif.l'N I'I(OVIDIII)1O1l Ili WELL OWNER
-II-off_
Itll('1IN(; 11111 \Vlil I. I/Al II
lilgplal it the Ilivlslou ur \Valor ()twiny, Groundwater Set'llun, 1616 Mail Scnlce (Antler - Raleigh, NC
tt 1'1) 731-322t. nllhlo :so daps. (I\' -I REV. 07/2I01

11rELL CONS'I-ItUC'FION 1tE(O1(1)
IJollll 1 molinp - )rpmhnenl or u,,virunnienl and Natural Resources - Division of \Valet Ounlity - (hunuldwater Section
t F /I� l� � I,�, n)
nIII In�111\f 11111 IINIII\'In11Al.1 NANI'. �rrlul) �ryVID_ �'_(: )�, r'11 N1w ___...__ ("EII IIPICA'iIONI�I
\t I I I I (IN I II \( I OIt 1-I)\II'.\N'1' NAIlE
2.-20e.tik.lj <1J I 1� I• NONE, M ay-tp
SI\II III: I.I ( ONSIIti'I 1 ION I'Ell1\11IU AS.SOUTAIEI) \Y1)1' \il1M
lit rppliruhk) (if nppliiablt')
I At.I I I. O`;I ll hell:.Applic;hle Ilox) Residential Municipal/1'uhlic ❑ Indn'mial O Aglictillutal ❑
Plrnrihn lute Cl Recotcly ❑ Ileal Pump AValet- Injection ❑ OIhcl11 Fr( llhcl. I. is1 lIsr
VA H 1. I, t ,A I IUPI //A�� G
hl"m r<I Itt' n' �lN/yVkk1y could),l� ter--L)r-ee
r'n, r tJ.nr,, _ Nnnr6,., I ommurnily, SubJivisiun, I nl No., Zip ('tJrl
gctiL_ Cnl_psCIo 3C •
l� Itirn,o.n Vnule Nn1
/ lu l aJ I. if
M ',ant- Zip ('ndc
.2.1 IXI • 11I.:17' .5 TcFt,-2
7
Vran I 1101'rii, ktirrn I.i �l
1 I t.\ Ili DI( 11 1.lif).5 '_c2.J- -c.) I_
a. I,)1..11 I/ITI IF
`/u7' -
I. I'111 C R'I'.I I. RI I I \1'I! IIXISIIN(i WPLI) 1'IiS 1 ND IL
7 IA11 \\'AIIRIi\'I.l. Iicluw "fop or('asing 6_n I1 ---
(the '4' it ALnvc'rup nl 1'nvinl•,1 __
A I I )1' 111 PACING IS / t I Above Land Stu late'
• I, I of r-odna grim'', lied al/or Lrino Ian\ Iurinre rtqulree • -- -- -- - - "-
•no Loire In armeThom nib 15.\ N('AI' 21".0118.
t). 111 I_D If'pml _ �- hilill1OD ' FIFST %9//2--
In AV.A 1IJ! IUtiI'S Wroth) / O 7_ ova' --
'lop( 'gi 1 /1.am!selling
I:Iltidgc 114 lope [Walley ❑Plat
(imck appropr ialc hml
I aliimic/longiludc of well location
275244
1'
1 nr Crres'ol inn, cs,< ccnn tit)
I. alit tidy 'lour ilurl(' somcc:l k71'S(7 topographic nl
(check box)
I )1.1' 1 I DKI LLINCG LOG
1-1ooni ) Po motion Dcscn Iiol�
_ y //0 _ 'nation
L G
IOI:AIION SKfiICII =
II IW:11.11-11'III IN: I yprilli,cf the Amount BCD ll'tvt shiny .inert inn and dislaticc in miles ran, k'4
I, (..\';INO 'Wall Thickness
t,r weight/Ft rt (alum( ui,,i,IItc, :Hid l'n111111011 lu:ld ❑:IIIIC,S. _.,
i)i liegth a,, t:Icr
1 lono ._0 1 rtJ C/.. I'1._ 6 �i___ Sbk 21 PiC
-
I itfl._
I l ono -.. _. 'I o-.--.-.- If.
II ( III( Ill 1c- li,"plh Material
1I1,1)1 C) I -75 I _ (PniEn)
I lord ..).'t -In 5(/' I . Gi.1 TT/'Vis
d C 1,-1,1IN Ilrpill I)ianlcler lot Sin:, M;belI
I non to I1. ill it
111on I n I —._.._.__.in. iu.
IS ',ArJD'Ii13,1\'I I 1'Ar I '
I ,1,ln
I rnnl
to I'1 LLVPF:'i:
11( lith
Io
Io
\
`IIIIIllll the rl i;}ILII 1 1 Ilia I
C Lll`Qy1440440N,(11'1)7
AS4'F ILL' P I'4L rirl.(l:C
onvir
Anon-
Si le hlalctial
I L__
Iwo Shur Ito:uls or County Roads. Include th'e roS4
O
y
111IIS W 111.1, WAS ('ONS 11211(.11 I) IN Al'('OItDANI t AVI I I I I',A N('A(' 2('. AVlll.l.
ANI)IN ,, A ('Oi'\ 1F'IIIIS Pi 1,1(1)11 S Il1'I.I4 I'Rt)VIDI!D IOl II1l WP1.L O\VNPIt
SI(.BA-IIJRP.1)I: I'Il(Sl)N Untgc, I It I ICI INU IIII\\fl I.
irisinn of \\'olt•r Quality, (;rtunldn:net Sethi,,,, 1616 Mall Sir \Ice (hurt- - I(nlrigll, N('
1 lin, ' thin 1(1 da\s, G\V-I Rli\'. (17/21101

275857
AN'ELL CONSTII.I_IC'I ION KI':CURI)
11n 1h' nrdin.i I it 1':unt oid of I; neinluulcnl and Nalulal Itc;uwcts - Uiekion nl \\';uel ()uality - (innu ul realer Section
rr 1 1 t r lit1111t 11':bl\'I nl1•\1) N:\a1P�whin_ _ 2-P1RP-y S (: EIt I IIluA l ION t4 3-22,5
rr 1 1 1 1 I )`: \ N 1' NA NI I! l�lteR(
1.+JQI.1 1'11tiN Of1_$'�$ 77_?$
':Intl rrt:l l.lrt\a11(I'1'll(INI'EIt\111 t/ A SS(l(•I\ II'111t 1r 1'1"ItdI11n
lit a, 11 it aldel (i I:glint ohle)
VA I I I. I1";1' I( Ii- t Algdicahlc IItix )' I InilwArial CI ,Aulicullmol U
(limo( tilt. II It,i lnr t\' LI Will I'untll \Nato htjcclion LI ()Ow( 1 1 I((nh1n, I. is1 I Ise
\\III. lilt,\ -111t11
Ilr,n r:1 tor, rr „Hu ,,��pp �`yy _
mom. PAs .r_RI3
r'-��� t I11nd . , . , n lnuniI) Slrbdi �idln,, I a1 Nn., lip ('adcl
t (r,',' Id l I'.
L0A4.1 ._ L4c_( _
�.,_.. rF'n., t n1 V.vulr No )
.:)04Q4sC1T . Wit_ 31-12'-iC
r 1 1 It Ili 7ipt'ude
19ti1 I . i 6 3y2 -
II\,,1r 11 „1Prt
ri)i llrlt -C3_
ItlIAI I)Il1,111 (p'S' _
tr It. C \, IIIRI!I'1 ,\('I'. I:XIC I IN(_ IVP.1..12 \ IiS C1 N) 1N'
1 ,\III \VA 11 I.1 I . Below I op of (tam), I/0 I 1
111or"1'If Allot,. lop of i1q•,1
t tl' 1)I- (,ASINi; I.i / I'.I . Altnve I.awl Sol lire'
' 1“1, 11 r;rd rq; to nrllm tnl nVnr lit Io s Imul 'whirr raluLev
>1I=.u, I ntunrr n111. I$•A N('A(' 7('.III IR. !�
(111\pl n) 5O Nth I1101) OI' iFSI ire
In \\ \ I III' 7ONI'S (tk plhC ..-____245 1 _ _..
I I I'I'IIN! I( I I
1' I,1 r:Rlr,.
Ib I'I.Ilrl'I;'
jYt lu gt:tlllnu/I.;md selling
11.Y(lOr. IlSlope [Walley Ul la(
1( Lrrt iipt'nic t'nnI
I alilurlallnnitiludc ul vcII location
35(r). I6C N — `d'1' L2. 367 Cc.)
Id krirr a'nm .tt •s'arrrlwd<I
I;Ilih11l - I l i l I le snulu I_I(il'SL] llgnlgrnpIiic map
(mink 61,t1
I tl l' III UIiII LRJU LAY)
Runt l o I own 1Ut n I)cscri1tlion
ENT
ANDNATU�RE$OUR-CE ---
RECEIVED
AUG 0 6 7N1
/� lad
I_I x-n PA
{j((�jt{!pFFICE
rJ I rpt'.l kkLo i -'c_ Amount /U�) p,,,pA \ Slttor thole'jl(�IIIl'U',W1rt�,rr'�T��-J�u{I ItAh, 01,1 Icasl
\tall thick uccc / Ircu Slultrl2.'�oRotiw,•'RYtrrtl3•7C41
I)in1u9Icr or AVcighl/II F I tl -tied numb,: :nnl r ounnrm mad nautcs.
II_
I\lnlit,al Plr•Ihr,tl
t
1)iamcIer Slul SI]C 1,1:11.., HI
I in. in
I in i11.
Si,c
I
hl:ucl Ut
rI1,(I111{Ulit 11I'lllirt.icit11tic VA'19.I.N'ASt'()NS11i11t.III)INA((1)Itl),ANr 10: 11111 c A N('AC 2(', WI7. 1
��
I - (rli _I NIYt Ito IN eII\NII DI*, AND l IIAI A COPY Or'IIIIS P.P(')RI) IIAS 111'1 t11'1It\' 11)1'. 1) Ill 1111 l\'GI.I. OWNI:It
. SII;NA II IItiwI I'IRSON(VHS IItI I('iIN(i"IIII'V',it1 NAIIt. I
1
.._ _St(h112ji_ Olt' nr ig inal Iollhr Iti eIsiwn of \Paler Oualily, (:ruuudlvalcr Section, Ie16 n1ot11 Sri sire (rutrr - Italrigh, NC
T'lna jr.tf I'lunc' Nu:,"l")7 V'1 1221, nilhlli 311 tlayt. (iAV-I Itl'.V. (17/2001

WELL CONSTItUC"I ION RI',COI4U
275856
Minch uo•11n:1 I it. p:ulmrntnlP.nvinmincnl and Nalural IL^:unrt'rs-I)ieisinn 4,1 Wn11•1IJ'mlily- ( innotda'alcr Sccllnn
p
\\1111I1`:I I!V lull ll`•UI\'lull:\Id NAN1I'.lVrL10_ �%U F2<-'-s F It 111.1CA I ION p__-Z_ —l�cp�
Irl ll,u;:l c.\r- l nit lc'\n•\NV NAME �l IZU �C` i•Je1I tti r%If`" 1.111)NI.N a2.' COgi
L e-.r D � _ L 1�s3 -�
�Idll ttl11 ( (INS I nf( 1 ION r i•:n111,fl ASS(II'L\11 II\\nl•I ll\ItItf
it a••In. aLleI /'I�I ahoy
\', ! I I. 11C1'. I('Ind Applicable lies): Residential B NIuniripal/I'uh!ie I I I,nlm:i,ial 1.1 A11licullur:1 ❑
(.b•ninn iur I Pr' Pi, 1v IJ II12;11 Pomp Wnlcr Injeclinn lJ OMIIc, I I II 1116r1. I lit' f In
\l II nr�\ I Ic ql
ri.. , Inat1 %`).1P 3LI (nnnly_�{V: QZI k
1 1.1• 41i.,1•1,4`i r�„�1lonull y, S116dici<iml, I ir! rJa_ 7_ip ('ndrl
L 116Ir,SQ,J
130x
Cop No 1
1 •,, I1••r 'di!, 7i11(tide
B )`b 1 ),I �1 35S `i
)
Iit ):(I Af111II RIPIiA�I {9SIRJ� n Inc ;-WII.1:1 YI•S [1 rill 111.' ... -
'•I \Il( \'',\III!II'\'lit. Ilelo\v' lop of(:icing:,5'(? I1
pi bc "1•'if AI'n c Impul'(n,inri __
' I nl' (rl PACING I'; fT Abavc Land Surl:rt —".
' I -'pi nl 1.ngn• Ienu111,1111 nl'nr I,rlu,v Inn! unlace rcnultes
•:1111nn 111 nr,wdxnu"•11h I5.\ NI'AI1('.OIIN.
" 11111)111)110 �,�.._ MRIIIOOO1 ILST 11-9
In \'. ',1I!I' I!)NI Col! rill) .- ..
II
1'
111':I NI IC II 1t I -I ; p't ,j1/41,rRry < _ IAutnunl _/C{7.�'���_i1
Wall ll)icknccc
11111'1
1 711111
hl Ilncicr nr 1Vci ghl'I 1 Ll;uclial
CY'I. .1u2Tf
Mn111in! PI'-'h1,11
1 )i:uncicr
11 in
II_. _.... in
11
11
111 1'I LIi1P.f,S
,,I
11'1'111111f111-L1j1II-11'111,A1 IIIISAVI'II.\\'AS(I)NSlI111-11 I)IN AC( l)pl1V'1'I AAIIII IsA N(-A(' 2(', A1'P.LI.
(11d. 11'n1 II pp! tilVr:)AI(IP AND I12IA(1)I'Y()1',IIIII.SItl'1J;1IIAS11111!'I'!tllv'II)I' 1)111 II II'VV FI_l OA1'NLlt
JAL—)
/
SIIII Sin`
Si;c 1\1:nr1 i:11
1.11111'1 3:11
I)lill,l.IN(J L0J
1 n[In:don I )c;ct:t ion
l'1lo ! ipluc l and selling
?rfltiilpi• 7.I I( pc U\•dlcy 01:1:11
pl lnripiritirite 1,0,1
I :q ihrl l• 'Inn!!ilu<b• ofn'cll lucaliou
lihn r I"nricnJr ,pint to -I I[ I S❑ I opngrapLic nun
liat Lo<)
III' I' III
l win 111
. (11-
1.- C)5
Slim,. Wit 1i,in ;1Ti}Z Q+IAEi"In miles lions al lead
I'vo 51.11. I',,;vl: o,, ( ouuly Rnads. lucludc time Wad
numb• 1� Ina , nnnll(!(t road o:nncs.
U y-c'S
SIG Alllltf ( I'GRSO (l)F 1 C11111; IlII' \C1111 I)AI It
rm
c
Sullolil ihr on{final In qIi - Division of \\'aler 1)uniily, I;fuundn alem Scrlinn, I,111 ',call .Sri %It (cider - Itall•11;Ir, NC
2ba" 1(.11• I'h-nir r4;11.10i'1)'7! )2)I, nililiu 311 days. (1W-I R14V'. 01/211111

275018
WELL CONSTRUC'I'IUN it ECUILI)
lirnlL l `n twin, - I )cpII hurl.' ul I [uvironlnclll and Natu{r{alItcsources )---t')ivision of \k::ticl I)mdily - (irowld\vatcr Section (�
\\III tIIN'lll.\I'11/11 (INII\'IIIILV.) NAME (piing /��}FZR r•..�n.)& > cut IIrIcA tI(JNMy_� j/S
11111 I(IN I It \(11111('IPII'.\N) NAND: CLQQV] �el ,DRi1l(v `' I'III/NF, M fvlV)8J• —OCXO
ASS()( IAa Ell \\ 1) 1'k:14\I I 1 H
(if Mold e:011C)
tit\II UIIL(11\SlltI'(lIIUN I'EIUNIIH
lit ;In dic:0 kl
\\1 1 I. I I':P. It heck Applicable !lox): Residential �Nuuiripal/I'uhlic 111 Inducllia' El Agricultural ❑
i\Inuilol log CI Iteeo(m' I7 Ileat Pump Wale( Injection U (1lhcl El 111 )Ihel. I icl I Ise
' VA'i'I1 itu'AllO1b
rlr:n ('sl Ilmll /)14 n t>
Colonyel1'RvkQf
Cof eti. O)LQLK_ kb
?Sur.1 rI:1nlr N , I.:i. I'nnnnlnlily, Su6dicivlun, 1nl No.. Zip rude)
uAy NI R' P.34 A_1_% CII`J
i...b i"3—_i-a4g— CT
L
Pr1 ,v It aloe I 1
A0.(l rt rc21
it. ia '�,,,,� 5.e(1c
('*i)- "6 oOG7
hip Comic
UI) . r\'I I. P.II. I.1[I) _y,)"-'—oS
s I,"A1. Ofpi II: Q5
It. On; S \vII 1 Itl:l`I AIM PXISI INC; WIILL. s//_1 NO tI
;I;\II( '\\'All1uI.P.\'GI, I)elow'for of(':ising:__ GO __1'1.
111,C "I if Abo'e l op of 1':r:i,q•I
Il )I'Id I ACING I`; / 11. Ahovc land SIP lire•
' I „p tit r.rdrq; her n1hI:Or,l alhn LrIon laud alrinre ((cgnl-ri
., 1 are LI artrnl au(e vllh I5.\ NI -A(' 7(.11119. /1
(I 111'11)Irian) . /)UNII'.IIIOI)Or'ILSI_—_L 11CL.__-
III \\�.\ I IlR /ONIiS IdrplhC /OQ....__/Eat
11 I11'411If(' 111IrJ Icl
Amount ---/()0
Wall-I-hiekncss
),•ptll l)ianiclrr 01 Weight/1 L ^^lalcli:d
I'II 11.
fo 11
--- e -----_ Nlalc r--.
I1 pull rlial Nlrlhrld
I o -f� 0 I I. �kaei. r �� ✓I1---
In J'�7_. ICI cirn75 in'r'
Ur 1 n U11m ICI Slat Si,i
I n Il. in. in.
l0 1:1 in. iu.
I'.AA'l I I'A, K
I rl plh
I Io111
111,m
Ib I'I P,LAKI(,`il
le, In Pi II'1 I'I121NI' r
1 l IIil IJ'SIANII —1 I
I.
1\i1
Nlalet inl
Ipl'III
loon In
lollop)' lc/Land selling
111tilluc I .lope [Valley ❑flat
Irheck pp/pp/mink. hiI)
I nlihulcluupilode of well location
I,Lpilr(rnr rs'ar(ll )
a1111111 r Inn11111I, s0111(e-13(11'S0 I opagr phic map
(Oink I,n%)
'WILLING LOU
_ I orrnnlinn Ucscliplinn
lot.— D5 Gr1s_ !TC
I.1)CA11ONSKE I CII
Sho\v air y•rlion and disl:ulce in miles lion al (east
I vvo Sl:llc Roads of COIIIIN hands. Include the ((Flit'
IIIIIIIbeit:: Ind renown!, road names. 0
J
Cy
O
Ca
J
fr1a
IIllSV1T.1.1,AVAS('()NSll(lI('IPI) INA('('(ntbArlt: vet Iil I sA N(-A('7( 1VPII.
, ANI)'IIIAI' A);,f)I'1' O .I IIf('1)IRO IIAS III'11J I'RI1V11)1'O1(11111; WELL O\1'NElt
AIIIRVY)p l'ER I�D)4(.ONS 1RIl('I1N(i 1111' \\'I 1.I
1_._4u1JJDil the aligiu,il lujlhe 1
l77.7d. 11161'lioni '1hbs(r)I'll 7t
o'sio t of Haler (Juallly, GI -muffin titer Set lion, la Ili Nlall Senice ''ruler - Rnlrlgli, N('
1221,niIhin31Idues, (i\V I ItllV.l)7/2(11)1

275 017
WELL CONSTRUCTION RECORD
Noir111 a1,111na - I repairmen! of Environment and
\\i'l 1. runt 11A('11m (INDIVIDUAL/ NAME ( 11)
\(I'I.1.(l/NIII,\( 11)1t ( (,Ml'.\NV NAnME__
SI.\II \'f I.1 ( (INS1111("IIVN 1•IS ltalll#
NAME
1 i f appliudlvl
Natural Resources - Division of Wnlci Quality - Groundwater Scclion p
/N} la �. �-'� -"V CEItTI FICA"rloN I.�i� /�
n �c .eSk1-l_._ _I l'l%.�)____ r iiiiNE • (656)g;7^&9O6(
4__ASsoCIAI F.P \I Q pr:INMI i a
1if applicable)
I \l'I I I. I I`:I' It'heek Applicable Ras): Residential Ll Munici1ml/Public O Indnsninl ❑ Agricultural 0
Nlmiloi ii p 111 Itecm cry ❑ I lent (rump Water Injection CI (Idler ❑ II( )Ihe1. List Use
\VI II 11 )('A 11t )N
Flr:u cst loan P/14.4l(44'l'-/ CounlYl /tL-'Ftfl
rnuer.i keLL_ Rt) ii r1,LiaK*
1 :'n rr Plnlnr Nmnhcr:. I nl nrrllmilt' Suhtlivicikn—tN
.rLotNo.. Zip Code)
)\\'NI it / ./ '47 PiZ� 1 )
/35 A/••LQyJ I LL kb
'nerl m R0111c NO.)
/:1(A)). r12�a3406
in,•�lo.n .'�'mr Zip ('ode
jQ-W)- 2/9N-?o2U
,pi (To one numb('
,I. IIA II'. I)UII.L El) G-3-03
5 T (11 Al. DEPT1 h_--,.. gS— EXISTI/
G NI 11'S \1'FI I. WTI ACE NG WELL? YES LI NO tic
7. S1 Al I('\VAl1.1t I.IJ.\'IiI, Below lop or Casing: 5O 1'1.
(Use "I" if Above lop of Cncinel
5 l 01' UI LASING IS / 11 . Above Lantl Stir thee'
•I op of colon r, ',luatrd el/or brinry rood nurlore requIree •
:Hi nor in nrrordnnre "Idr 15A NfAC I(2 .al IR.
i) \ 11 1 D (('hNo: _.�U MI Tlt0D OF TEST if=----
e
In WA Ills /.GNFS ((krill): /lip ---
topographic./Land setting
❑Ridge CISIo11c Walley L7flal
(check noting-oinkbox)
I.aliludc/longitude of well location
bl rprrev/Minute slrcc ands)
I.ul imdc!Ilmgiludc sum cc:O(il'Sl7Topograpliic (nap
(check Om()
DEI'III DRILLING LOG
I tom Tn Formation Ucscrr noon
0 ..52 6 Q- (;.RA ✓eL.
I1 I)ICINI-11'I1ON:-Ivpc ` 'i\1.ckl,h/e
12 (',\SIN(F.
I !ion 0
Ikpih Dian11Slcr
C"q 1
runt To It.
Antolini _/QQ
Wall lliicknesa
nr \Vcight/FI. month,
SDR1I PVC
11in11 lT II. _.-_- —
11 t Mt ICI Depth hlnlerial Noland
9/-
I11n11 'JO_- I0 Jg 11. L-"1' ti)yS "CPA ✓<r.y
Id. 11 R11 ..I 1. Ucplh Uimucicr `�Iul Size ` Malt' al
fn,ln to I' 1. in. in.
I11•n1 In 11. 111. III.
IS SANII/GIt AVFI. 1'A(K
Dcplh Site Material
0,111_-. �/_ -I-" �' '('-- I L.__9;ingse'
Ii not To FI.
1n)1n
IG It1.ALARM S.
hl u-N41=1H-I+F +I11-11 It-1411Ij\
1' v_1 (()Nis Pill:11ON SIANDAI!I.,
LOCATION SKEI CI I
Show direction and distance in miles from al Icns
Iwo Stale It(nds or County Roads. Includtaie rojl
numbers :u111 common road names.
I ITS WELL WAS CONSTRUCTED IN ACCORDANCE WI III I 5A NCAC 2C, WELL
AND AII IAT A COPY UI''Il ITS I3.k CUltl) I IAS BEEN I'fuV IDED 10111E WELL OWNER
ita 6-6-03
EOFI'i!TISOSI'WelIND11111Wlil.l. DAZE
Sulnrtil Illy ini(lnal tnl III4 Div sloe of \Staler Quallly,h;ruunilwaler Section, IG3G Mall Scr\Icc Ccuicr- Raleigh, NC
21694 1(36 I'hmic No. 1919) ;3J-322I,1111hln 31) days.
OW -I REV.01/2111)1

2750I6'
"Ft AA PRATT-
1 35 /LLQ,-,)-_?_e_L IUD
lU 11 L !`/\ OJISCI
T n ", C1:nt� 7ip ('' Ir
1(6 )- 2Q20
WELL CONSTRUCTION RL('t )ILI)
11.411t, .m 11in:1 • I !ep:uluv.-n1 nl I ii innitucnl and Nalurnl Itcst,lur;cs - Division r,l \\ al(•I I )uglily - (II olititlwater Suction �y
1%111(n\In V' I VII IINNIIIIIIIAI.) N.\Plr b[ll ___1)_(gV,,_cy (r-•t ��-)nn'e-- ('P.It I IP ICAl toNNp.�1.5.
,)111,II\III I IIIUI (IVeAN\NAME _ . .' 1^c.t_ LL9.(L,(. b tt I'�� 1'111/NE N( )o�$uoy
tI\ II 1 , 11 I ((I\ SIUI( lIl)NI'IiItMIIM , A ss(nIA IIl,\I)I'I l)III,I
(1111 ' ti lt:Iblc 1 (ir applic.lt)l( )
\\ 1 1 1 11';I- 1( lint1, Applicable Ilox)' Rcsidculial Alllnicipal/Public I:I lu,lu:nial 11 Aplicuhurll Cl
\Il11112.l in!! I.1 I'.crn,! Ir L.1 Ileal 1'un111 \Valci hrjceli,nl I UIhc1 L_l II14ht1, I i:1 Ike__
R'111I 1rn':\1I1)IJ
.nr51 I lilt❑ Mt(
A Li e) 113 R)1
I:Pm, I IIIIIilq. C ll 1 <i<ii1ll, I tll tJo. Lg, (-rnitI
I\\-N I' It -
I'hurt IIInbo1
DAIt Dim .1PD �-)-03
I I 1 1 AI 1)1 111 I I'.
pg1
C) Ir1 5fi
3U5'_
DnP; \\'P.LI. I I l9.;\1'I' PAISI !No will? YES S Ll No R ----
\ I I(\\'All:It l I\'II Il:low "lop of ('asiug: _ I --I _.--
•
H. OI-(',\SIJJ(I I`: 1'T Above i.nnd Sulfate' -
l npinn ophic/I.I1I Iling
1117i,Irc I ISlopc BI':'Iles- Di hi
1, Ilctr gl,npr i:llrhn<I
I :Ililud(''lougdudc nL vlell ItC:IIil)II
:Ilinldr'I u n 1d, so,llt c'l 1( ;1'SI1 Popugr-.q,hic map
I111rh I 1
1)1 1'1 11 I)RIt I.IyU
lun1 to folmdnu Ucsu gaiou
Ci S GIS 1 � 6-
I Iq, ,d r.,ili(• Irnnl IIlIrd'ring brllnv I11111 m,larr «gnbr,
Im 61 :Ir(nr J:o,tr „Ini IS \ NI A(' 2( .al IP.
". 111�1I)ll,l,lnl /C)O A11i1111)1)ul` I-IiSIA/411-.
III \\•\Ipit /i)1JI S((L_plb}
0
�A-.
I I Irl`:I,11 PI III )11 1 ‘1,,.CkkL.op„oe_ Auinud /nt) f7�K Sham diI-rli,In :nil dl.l:ulrc in Miles limn 11111c;rsP
\'i1N1ll'
11'•111
11111
11' 1'I 111.2.
Wall lbirk nc :: - hvo SI:Ill' It,rld': 01 1 1111111V ltna(Is. IncIIIIIC» itr
DianMlcr nr \Vci 11121I. 11 ilc11.11 munhcls :Ind t'n111n1,I1 ,u:111 names
p1 G J" Qi!c_
nI:III'11111
CuTn'vgs
Di:nnelcl tlnl Sin
n1:11e11:11
NII•IL,III
N.�
�_
11111(1 P 14fl � (k�l I I I IIS V1'f LI. AA AS I uNS I RI I(' 111 I IN AV( �(qt UANI P AA'I I 111V NI( Al 2( . A1'ILI.
� I �l i Ip+Llat l�r,vIII Y; AND III -A(UI'v' Ol 4_I111 III (1 Iin IIAS III 'I'RI I'Ituv'INI D III "I I II vAIfI.I. UAVNI'R
vi i; J o < -1 a - C� - -�3- -
rc _-• I SIt A1111(1 ) I'IiItSUN ('O it I('IIN(I 1111: \\'III. UAlli
(
I• 1-61111hlhnrr igirv:ILJ,1 the I)ii isiull of \Valli (lualil), (;I'nuudt,nler fill lion. Ib}l. I\ I:JI Sri 'Itr ('colrr - It:delgh, N('
_(c_ r bgrt'16 t(, Ili n, Ni I"1'II �)1 1221, isillrin 31111:ns. (i11' I In . 111/2IIIII
0
I II('A IIUN SKU.iCli
g305
L
111;1

2. W ELI,I UC•A I Rift
I,^.Urrl Nnm., NuniFrlt, C;:::::•, ,,,nv, S,IUJivitlon, 111 No., Zlp C,•Ir)
/ 1
). (WHEEL t 0zri �� JZo/ `/o
AOdic 55 ism\_ w_Q„e0\_—
'WELL CUNS'I'1:UC'IIUN IIGCiiiu,
iNollh Cnloliva - Depal(mcnl or E ilvironmcld nid rinlu(al Ilesoutccs - Division of Water Qunlily - Choundwnler Sccliun ��Mv\CS �- L�l,cbn crillirICA-HUNr.P-C/a4(
(arl,l.coN n(ncum Nr+nlrlulrnl,)NnnIF u,r lnl ilium: 1 L4J`s14�7-244 Y
wr,l,CON I ltnclvn cc/Nu/vile NnnIF. 1r ln��-�1 C�Cn�`( J
ASSUCIA I VII WO FERMI I I —
slnlrrrrl.I, EONS lWWI 1NN I'EIIn111� -- --- inldicnllc
I.lUSh (Check k Applicable
Ilua)lcs!dculinl IIJ—hluuicipal/Public U IuJuslrinl I l Agticullulal U
plottiol iug U Et-covet).
0 I lc:d Pump \Vold Injection CI (Alicr Ld If Other, List Use
�r L
N tcsl Io,In ±Lcp_ _,� —Omi), Cio.eC17
(Sorel m Rome Nnl �����
Q(1 �C ni l.11
zl 71 Code hlolll 10 Q��
on' SIMe
D 70t J
Arro rNIr rh,.ne „her
. n. DArh Don lr•Div - ID _3 —
5. I o rot. nee 1 n:_-02,2,6-'------
6 UUp.S WI!LI. REPLACE PXISlltlll W'h.L1;! VhS U r o Ll
7. SFA11C\VAFEE LEVEL Below 1oil orUnsiip _olQ'__E 1.
(the •'I"NAbove -lop ol Cnth,e)
R. l 01' Ur CASINO IS _ __L_ ____ 1 l'. Abnvc I.mul Slitl'nce•
. I rp rl t.dne irei,iI i 1 .Itrr lirhn I.ud ono Lre trnullrt•
,.,I.nrr In .rrrnI iItt nllh I5A NCAC IC .n1IA.
V. 1'IPLU (nun): __r_7__ __ p1El IIUU Ur tt!ST 2 _ _ __ 1(1. \VA i ER ziNr.s (depth): — Luc:m.10..N s t...Lu ,'
ad Amount _LS Show (Btecllon nntl (1!nlfntce 111111!les Bon nl Icnsl
1 I. C S INU IUN: l)pch�. Wnll lldckuc+s Iwo Slide Itonds or County Itonda. Include the load
12. CASINU: numbers and common loud ❑antes.
µ� hrplll Uinn!clrr m/ (\�VrigbVfl. (h�lnlrlinl
I. tolll__11— In jr)r 1'1._�.,_2$L .�K:Z— .p.iLC—
Elpm_ n`'— Ft
274815
floral___ Io_—',-- -- Method
l)IIIIU!^ hrpllr
all
1 tom
Uinul_l❑ Slut Size M1Inleiinl
IA, SC!lLL1J� Depth Ili
Mont_ _ __
I tom _.I o_ _ _.- E'I. _in. _--
.ro_ I I it, , M. -—
15. SAND/GRAVFI. l'ACK: Sire M1lidrllnl
Urplli
•1 o__ 1'I.
to II.
'I (yogi nithic/l,nnll 'Ellin[
Ultidgn I npc I-1Vnlley Ullni
(check eppnnnlno- btu)
I.nllludc/luugilude of well location
1 /✓351i0' �t W 8 t 03"01
1iL 2fgoce iiSy( plrrrrrdndmnruh-:nod,)
LnitImicli.,ng!lude source:U(11' S(_I I opoglnpllic 111,11
(check! n
WW1 .WC; LUU
rounaliull Desciipliun
Mont
I'mul
LL-`LoIIL, , 1 , ri
I DO III-nr115 Clad 0 1IIAI 11115 win I. WAS CONS I Enid I'D IN ACCURUANCIl tell II I5A IICAC 2C, WELL
cotlslltucl luris F wows, ANB'I liA r A col'Y 01' 1111S RECORD IlAS BEEN PROVIDED 101112 WELL OWNER
---- CONSIR +
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