Ch CY2005

WELL CONSTRUCTION RECORD 3
North Carolina Department of Environment and Natural Resources-Division of Water Quality �5
WELL CONTRACTOR(INDIVIDUAL)NAME (print) BENJAMIN M.GANTT CERTIFICATION#2092
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):Residential13 Mtmicipal/Public❑ Industrial❑ Agricultural❑
Monilofing❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use -
2. WELL LOCATION: Topographic/Land setting
Nearest Town:MURPHY County CHEROKEE ❑Ridge )❑Slope []Valley ❑Flat
5222 BOILING SPRINGS RD (check appropriate has)
(Street Name,Number,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: JAY ARROWOOD (degrces/mmutee/seconds)
Address 5222 BOILING SPRINGS RD Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NG 28906 DEPTH DRILLING LOG
City or Town State Zip code From To Formation Description
6( 28 y 361-6365 0'TO 50' RED CLAY
Area code-Phone number 50'TO 6T SANDSTONE
4. DATE DRILLED 021011/2005 63'TO 7V BLUE GRANITE
5. TOTAL DEPTH: 605' 7l'TO 605' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 0
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use'W'if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface"
'Tap 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): 590'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two Slate Roads or County Roads.Include the road
Depth Diameter or WeighUPt. Material numbers and common road names.
Front +1 To 70 FL 6 118- SDR 21 PVC
Z
From To Ft. 5�
From To Ft. C"rr
13. GROUT: Depth Material Mcthod f-M 1711
J1 -r1
From 0 To 20 FL CEMENT GRAVITY 4 M- ;;0
From To Ft. t _
14. SCREEN: Depth Diameter Slot Size Materiel CA
.-S' `J --rc:
Fmm To Ft. in. in. N v �r.I�J cc,=
From To Ft, in. in. ,� AA�C� 3G -+-,U
15. SAND/GRAVEL PACK: - W
Zp
l
Depth Size Materia '✓
P N cn rnp
From To Ft ,�' J
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS.AND THA``TT�A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF •RSON CONSTRUCTING Tl19 WELL DATE -'
I J i
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center- '- 00 `
Raleigh,NC 27699-1617, Phone No,[phone],within 30 days. = ='
OW-1 REV.03/2004
7 -
cal

bcp
WELL CONSTRUCTION RECORD y 9
North Carolina Department of Environment and Natural Resources-Division of Water Quality 0 ` J 5 �]
WELL CONTRACTOR(INDIVIDUAL)NAME (print) BENJAMIN M.GANTT CERTIFICATION N 2092 /G
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 MunicipaliPublic❑ Industrial❑ Agricult ral❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other D If Other,List Use
2. WELL LOCATION: Topographic/Land Setting
Nearest Town: County CHEROKEE )❑Ridge ❑Slope ❑Valley []Flat
PEACHTREE HILLS (check appropriate box)
(Sheet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3506.258NI8357.721 W
3. OWNER: MICHAEL MINGUS (degrees/minutes/seconds)
Address 2495 HWY 141 Latitude/longitude source)DGPS❑Topographic map
(Street or Route No.) (check box)
NC 28905 DEPTH DRILLING LOG
City or Town State Zip Cale From To Formation Description
g( 28 } 361-0551 0'TO 30' CLAY
Area code-Phone number 30'TO 100' SANDSTONE
4. DATE DRILLED 01127/2005 100'TO 108' CLAY
5. TOTAL DEPTH: 605' 108'TO 605' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 35 FT.
(Use"+"if Above Top of Caring)
S. TOP OF CASING IS I FT.Above Land Surface*
•'fop ofnsmg terminated atlor below land surface requires a
variance in acnrdance with 15A NCAC 2C.01I&
9. YIELD(gpm): 4 METHOD OF TEST AIR
10. WATER ZONES(depth): 130'-2 GPM,4W-2 GPM
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From *1 To 112 Ft. 61/8" SDR 21 PVC
From To Ft. 0-�
From To Ft. y
13. GROUT: Depth Material Method �4.r �,Jtti
From 0 To 20 Ft CEMENT GRAVITY
From To Ft. Q y
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. 3 CA
From To Ft in. in.
rri �<
15. SAND/GRAVEL PACK: ? to -urn
Depth Size Material tI p0�
From To Ft --tom
From To Ft C-)=
16. REMARKS: —zC3
tV c)
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TH " A COPY OF THIS RECORD HAS B EN PROV DED TO THE WELL OWNER
SIGNATURE r
RSON CONSTRUCTING T11E WELL. DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mall Service Center-
Raleigh,NC 27699-1617, Phone Nm(919)733-7015,within 30 days.
GW-I REV.0912004
MAR - 8

WELL CONSTRUCTION RECORD U
North Carolina Department of Environment and Natural Resources-Division of Water Quality 3 0 ry 3
53
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CALVIN W.ROSE CERTIFICATION#3327
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential 13 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2, WELL LOCATION: Topographic/Land setting
Nearest Town: AuQPiAX CountyCHEROKEE )❑Ridge ❑Slope ❑Valley Mat
TARHEEL PROPERTIES-FOX RUN 1 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: MICHAEL MINGUS (degrees/minutes/seconds)
Address 2495 HWY 141 Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
/Y(A(j�: E NC 28905 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(828 -361A551 0'TO 77' DIRTISLATE
Area code-Phone number 7T TO 360' GRANITE
4. DATE DRILLED 01125/2005
5. TOTAL DEPTH: 360'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO Of
7. STATIC WATER LEVEL Below Top of Casing: 90 FT.
(1se"i"if Abwe Top of Casing)
S. TOP OF CASING IS 1 FT.Above Land Surface'
*Top orosing terminated atlor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 15 METHOD OF TF,S7' AIR
10. WATER ZONES(depth): 105'-1 GPM 330'-14 GPM
L(H:A'C10N SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two Stale Roads or County Roads.Include the road
Depth Diameter or Weight/F[. Material numbers and common road names. Yt7�
From «1 To Pt 61/8" SDR 21 PVC G�
From To FL
rn
From To Ft.
13. GROUT: Depth Material Method �O
From 0 To 20 Ft. CEMENT GRAVITY Co o�
From To Fl. r
X 4v 14. SCREEN: Depth Diameter Slot Size Material \ Z " :;oFrom To Ft. in. in. (� 2From To Ft. in. in. Nrn15. SAND/GRAVEL PACK: J n
Depth Size Material
From To FtFrom To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELI.
CONSTRUCTION STANDARDS,AN"TA A COPY OF THIS RECORD HAS BEEN PROVIDED 1'0 THE WELL OWNER
ATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004
1i4,.F

WELL CONSTRUCTION RECORD 307354
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME(print) BENJAMIN M.GANTT CERTIFICATION#2092
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # (828)837-BOOB
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):ResidentialX] MtmicipattPublic❑ Industrial❑ Agricultural❑
Monitoring O Recovery ❑ Heat Pump Water Injection❑ Other D If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:MURPHY CoumvCHEROKEE ❑Ridge $]Slope ❑Valley OFlat
SUGARWOOD FOREST NEAR KEENER RD (cbeck approptiale box)
(Sired Name,Numben,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: BILL DAVES-FOXFIRE REALTY GROUP (dcgrees/minutes/seconds)
Address 20 TENN ST Latitudellongitude soume:DGPSOTopographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town state Zip code From To Formation Description
(828 . 361-9419 V TO 10' CLAY
Area code-Phone amber 10'TO 80' SANDSTONE
4. DATE DRILLED 01125/2005 80'TO 115' CLAY
5. TOTAL DEPTH: 205' ,.,/ 115'TO 205' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES 11 NO uq
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use-+"if Above Top of Casing)
8. TOP OF CASING IS I FT.Above Land Surface"
'Top nfessing terminated at/or below land surfuce requires a
varlance in aecordsocewah ISA NCAC 2C.01IS.
9. YIELD(gpm): 60 METHOD OF TEST AIR
10. WATER ZONES(depth): 130'-5 GPM 180'-55 GPM
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road 39
Depth Diameter or Weight/Ft. Material numbers and common road names. p Gr�rt
From +1 To 120 Ft. 61W SOR 21 PVC Na'1 Mr"
From To Ft. -� Cr7 Mr"
From To FL @L'�� to -om
13. GROUT: Depth Material Method 1� �,� Co C O
From 0 To 20 Ft. CEMENT GRAVITY
11 ��
From To Ft. =C .4w
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in. N ,
From To Ft. in in.
15. SAND/GRAVEL PACK: 3
Depth Size Material as
From To Ft. �.
From To Ft. p
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BE N PROV 11 D TO THE WELL OWNER
SIGNATURE O RSON CONSTRUCTING TH WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
OW-1 REV.09/2004

WELL CONSTRUCTION RECORD 3 Q �3
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVID F. MCKINNON CF.RTIFICATIONN2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE N (7061837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
l. WELL USE(Check Applicable Box):Residential91 Mtmicipal/Public❑ Industrial❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. W13LL LOCATION: Topographic/Land setting
Nearest Town: M vZPIAY County CHEROKEE Midge )[]Slope ❑Valley ❑Flat
NEAR ENTRANCE"ORTON EASEMENT" (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: THE SANCTUARY AT VANCE MOUNTAIN (degrees/minutes/seconds)
Address 4750 ANDERSON RD Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
18)_A)R6,;.t1e GA 30512 DEP17I DRILLING LOG
City orTown State Zip Code From 'to Formation Description
(706 - 835-6300 0'TO 30' BROWN SLATE
Area code-Phone number 30'TO 55' GRANITE
4. DATE DRILLED 01/14/2005 55'TO 180' GRANITE/QUARTZ
5. TOTAL DEPTH: 505' 180'TO 299 GRANITE
6. DOES WELL REPLACE EXISTING WELL? YE. ❑ NO � 290'TO 292' MARBLE
T STATIC WATER LEVEL Below Top of Casing: 6 F 1 292'TO 480' GRANITE
(Use"+"if Above Top at Casing) 480'TO 505' GRANITE/GARNET
8. TOP OF CASING IS 1 FT.Above Land�urfacea
'Tap ofcasing terminated Wor below land surface requires Is
variance in accordance with 15A NCAC 2C.01IR
9. YIELD(gpm): 50 MET]IOD OF TEST Alf
95
10. WATER ZONES(depth): 229-45 GPM 275'-5 GPO BIT SIZE 6. LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount W PPM Show direction and distance in miles from at least
12. CASING: Wall Thick less two State Roads or County Roads.Include the road
Depth Diameter or WeightlFt. Material numbers and common road names.
From 0 To 54 Ft. 61/4- .188 GALV
From "to Ft.
From To Ft. � 1
13. GROUT: Depth Material Method te� A Cl1 .o
From 0 To 54 Ft.NEAT CEMENT !PUMPED �� k'D _
From To Ft. ,� '�,pm
14. SCREEN: Depth Diameter Slot Size Material �J 1 o�
From To Ft. in. in
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material Z.,Cn
From To Ft. r? (� N rJr{y
From To Ft. "'"1 n
�1
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS,•i�RUCTED IN ACCORDANCE WITH 15A NCAC 2C.WELL
CONSTRUCTION STANDARDS.AND THAT A�COP�Y OF`�.TH/IS RLrCRSRD HAS H EN PRRO IDED TO THE WELL OWNER
SIGNATURE OF PERS01 CONSTRUCTING THE WELL DATF,
Submit the original to the Division of Water Qualily,lAtln: information Management,1617 Mall Se vlcc Eenter-
Raleigh,NC 27699-1617, Phone No.[phone],withih 30 days.
GW-1 REV.09/2004
MAR
I

WELL CONSTRUCTION RECORD 30 7366
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION a 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE a [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
l. WELL USE(Cheek Applicable Box):Residential LI Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:MURPHY County CHEROKEE >DRidge ❑Slope ❑Valley ❑Flat
CANDY MTN.RD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3506.208N/8416.475W
3. OWNER: JOE JONES (degrees/minutes/seeonds)
Address 225 LAKE FOREST DR Latitude/longitude source)❑GPS❑Topograpldc map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTII DRILLING LOG
City or Town State Zip Code From To Formation Description
(828)_4944913 0'TO 20' RED DIRT
Area code-Phone number 20'TO 40' BROWN DIRT
4. DATE DRILLED 01114/2005 40'TO 100' BRWON SLATE
5. TOTAL DEPTH: 265' 100'TO 140' DARK BLUE SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑ 140'TO 265' BLUE SLATE
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS 1 FT.Above Land Surface•
-Top orcasing terminated it/or below land surface requires a
variance in accordance with 1SA NCAC 2C.0119
9. YIELD(gpm): 50 METHOD OF TEST AIR
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least 9
12. CASING: Wall Thickness two State Roads or County Roads.Include the ad Grn
Depth Diameter or Weight/Ft. Material numbers and common road names. �( n
From 0 To 140 Ft. 6 1/8" SDR 21 PVC
iTt 70.G
From To Ft. C7 Vr'n
From To Ft. CD
13. GROUT: Depth Material Method —4
From 0 To 20 Ft.CEMENT GRAVITY \ a C)
From To Ft. o
14. SCREEN: Depth Diameter Slot Size MaterialY�
From To Ft. in. in. rrq
From To Ft. 'tn. in. n
15. SAND/GRAVEL PACK: 4P
Depth Size Material �s1..rOu/ �raT1
From To Ft. / /\AeA
From To Ft. J
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 IS RECORD HAS BE. PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,16I7 Mail SerAm Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. - l�'
GW-I REV.09/2004
MAR - 8 2005

\1�%
WELL CONSTRUCTION RECORD C 307368
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVID F.MCKINNON CERTIFICA7-ION#2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED W Q PFRMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential11 Mtmicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heal Pump Water Injection❑ Other O If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE )ORidge []Slope ❑Valley OFlat
MT.PLEASANT RD.TO KEN-WOOD TRAIL (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of Well location
3. OWNER: KEN GALLOWAY (degree,!mimaca/secrmdr)
Address P.O.BOX 883 Latitude/longitude source:OGPSOTopogmpWc map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
city or Town State Zip Code From To Formation Description
(828 } 361-2096 0'TO 15' RED DIRT
Area code-Phone number 15'TO 75 SANDSTONE
4. DATE DRILLED 01/2512005 75'TO 85' BOULDERS/DIRT
5. TOTAL DEPTH: 705' 85'TO 97' BLUE SLATE
6. DOES WELL REPLACE EXISTING WELL? YES U NO ❑ 97'TO 140' BLUE SLATE
7. STATIC WATER LEVEL Below Top of Casing: 100 FT. 140'TO 360' GRANITE
(Use" "if Above I opofCasing) MO TO 705 GRANITE
S. TOP OF CASING IS 1 FT.Above Land Surface"
•Top of casing terminated Wor below land surface requires a
variance in aaordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 3 METHOD OF TEST AIR
IO WATER ZONES(depth): 420'
L(X7A'fION SKE"I"CII
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wa11'rhickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. )L'
From 0 To 97 Ft. 6US' SOR21 PVC
From To Ft.
From To Ft. ^
13. GROUT: Depth Material Method r�j Q tT 'a
From 0 To 20 Ft.CEMENT GRAVITY
From To FL 3 177 -am-
14. SCREEN: Depth Diameter Slot Size Material 't f
From To Ft. in. in. '�
M
From To Ft. in. in. sr 1,` n2
15. SAND/GRAVEL PACK: o
Depth Size Material CW ;yo
From To FL ty r From To FL 1' co cmi
16. REMARKS:
1 DO HEREBY CERTIFY THAT"r111S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS.AND THAT A COPY OF T IIS RECORD HAS F.EN PROVIDED TO TI IF WELL OWNER
%
SIGNATUR OF PERSON CONST UC77NG THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004
6"AA - 8 2D05

DA_�/
NC 04JNLR MVID
307359
WELL CONSTRUCTION RECORD
Not Ill Cmolina-Deparhnc it of Ettvi(onntoul and N\_almal Reso(uirces-Division of Water Quality-Groundwate Seclion
w'F.LL CON'I RACIFOR(INDIV'IDUAL)NAI1fIF jr,�tiol) MSS --K`` ,W^I I -,nn CER'IIFICATiON N.),V ULI
WELL CON]HACTOR COMPANY NAaIEW'ltt�E11 C`f i1'�r1A rIIONE N 132D9V57-25�tl
STAI F NVFI,1,CONSTRUCTION rEMI1TN — ASSOCIATED WQ PF,RINITt1
(ifapplicabic) (ifapplicnblc)
rnre-namrtll�aonteo��altttttttr�lsl®I�II�llaitrtt�rlterlotttttttaaaetr®I',
I. WELL USE(Check Applicable Box): Residential a-muuicipal/rublic❑ hnlushial ❑ Agricultural❑
Monitoring LI Recovery ❑ heal Pump W:dcr Ittjcction ❑ Other❑ If Other,List Use -, .'i
2. WEI.LEOCATION: - 1
,,An�/1 pogrnphicJLmld selling _ 0
Nearest'of�n'1'IUL�IE1_ _-Cotill14�1C,rL�� 61ndge ❑Slope ❑Valley ❑I7iat -.
(chcek npp,,pd le b") �O
(St¢•I Name,Numbnc,Crnnnuu.ily,Sulvluicu n,tea It Lq 0..Ic) Latiludellongilude Of well location _ tr
3. o.,vr1l.R.r' I�r;.s--1;-Od1t�- -------- __ (degreealmmvlydcm.�nJc) . . .
Addlcss L1L L-
y� t_I:�;L��_l� _-_- Lalit,dc lun1;iludc sou[ce:❑(iP. ❑Topcgtapbic Amp
(Sheol a Rome No,) (check Noo
Cily.+r"lmvn Stale 71pt'n4e Front To {'orroalion Description
0 -
A+r+o..lr.fbnnr mnnher - Ir) J-
4. DATIiDRILLED1 - -2�u-
1 —
6. DOES WELL RFVLACE EXISTINO WE'LL7 YES ❑ NO 19-
7. STA7"IC WATER LEVEL Dclow'Ibp of Casing:_.`�Q _I 1.
(Une"r'if Abuee ll,p M CxeinR) .
8. TOP OF CASINO IS_ ( __ Fr.Above Land Surluce' -
•Tep of otlne tonrtaxtnl cllnr hAun Imd.otfcce rrgnlrn a (�
rnlmce In ar,.rd.wt wlih 15A W kC 2C.Alta.
9. YIELD(gpnl):_+,__MI4II0U OF l'FSl'
10. WA-FlgR !ONE'S(depth): _
�� L-2Gr MIN_S.K MI
11. DtSI1JFIfCIION:'hyPc 7 Amomd Show direction nod distance in miles Dorn at lead
12. CASING: two State Roads or County Roads. Include the roa
Depth Dinmelcr or WeightiFt. Mnlclial mtlubets and cunt on rand names.
From, "ro Ft. ---- —
FronL`To._. 1 1' - --- -----
13. GROUT: Depth d
10
t�tnlclinl vie
Ideslu, T+'
Ftom—_To__FI. ---
14. SCREEN: Depth Diameter Slot Sim Material
From 'fn
Front To Ft_in. _ iu. _ �C(Qj V E' -;7 LO.
15. SAND/GILAVFL PACK: rp pS
Drpth Sire Mnlcri:l S -4:
Ftool To I't. cJ xa
From To Ft. 1(A 1 W C)
16. REMARKS:
DO I IFRFDY C FRrIFY TIIAT I111.9 WFI.I,WAS CONS;I lill ICIED IN ACCORDANCE WITII 15A NCAC 2C,WELL
CONSTRUCtION STANDARDS,AND TI IAT A COPY OF l I[IS RECORD IIAS BEEN PROVIDED TO TI IC WELL OWNER
SIGNATURE OF PERSON CONS IRUCIING I Ill!WELL DATL'
Submit the original to(Ile Division of Watrr Dun Iily,GI oundwn ter Section, 1636 Mall Service Center-Raleigh,NC
TT609-1636 Phone No.(910)7JJ-322 i,wllhhr AI days. OW-1 REV.0712001

NC ✓ OWNER MWD
WELL CONSTRUCTION RECORD e�
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME!,(primp , lfar✓le-5 Q, i„'):kn✓1 CERTIFICATIONp
M1 a40Z/
WELL CONTRACTOR COMPANY NAME U9-C SLQ1I r�fy�l_vZ�PRONE # (4r2R) Cc37-..?967
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(ifapplicable) (ifeppliceble)
1. WELL USE(Check Applicable Box):Residential 01, tunicipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. W ELL LOCAT N: TopographicJLand setting
Nearest Town: ;)_County licl I.L ❑Ridge LlSTope ❑Valley ❑Flat
lo D ham (check appropriate box)
(S ttre t Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: 0 y e i�PC� (de�ee✓minutes secondr)
Address L+9 -ro p A C Latitude/longitude source:❑GPS❑Topographic map
(Suect or Route No.) (check box)
A-n Ayr e,.i c Air- 2 9 D I DEPTH DRILLING LOG
City or Town State Zip Code From TO �orrnptfon Description
)- n I r)
Am code-Phone number I Irk _ a P, r
4. DATE DRILLED 1-
5. TOTAL DEPTH: ,2(n5
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO m-
7. STATIC WATER LEVEL Below Top of Casing: 5C FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS I FT.Above Land Surface* crn
•Top of cuing terminated at/or below land surface requires■ 'n
variance In accordance with ISA NCAC 1C.01 I6.
T1 ratrrt G
9. YIELD(gpm): i Q METHOD OF TEST_���_ G7 -ao
10. WATER ZONES(depth): r o
LOCATION SKETCH Frrtr�*t
11. DISINFECTION:Type`1 -s Amount I Show direction and distance in miles from at lead
12. CASING: Wali'lbickness two Slate Roads or County Roads. In lude the road ,=)
Depth Diameter or Weight/Ft. Material numbers and common road names.
From-_ 0 To aS r FL (o,aS CTD1 D✓� si �1 +� �j/-husc" n
From To Ft.
From To Ft.
13. GROUT: Depth Men
From 0 Tom Ft. yj 0( 'o
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
a2 Q. jN1 GS eq,f
From To Ft. in. in.
15. SAND/GRAVELPACK:
Depth Size Material
—#e na•
From To FL `p, �f 2d
From To Ft. -
16. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
/ - co
SIGNATURE OF PERSON CONS]RUCTING THE WELL DATE
0
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Ralelgh,NC
-.
27699-1636 Phnnc No.[phone],within 30 days. GW-1 REV.07/2001

NC (/ OWNL=M MWD l�
WELL CONSTRUCTION RECORD 3 p
North Carolina-Department of Environment and Natural Resources-llivision of Water Quality-Groundwater Sectiion'
WELL CONTRACTOR(IN UIVIDUAL)NAMK1 (p\rint), '"wl�'1S �, I,it `S Tl Ln CERTIFICATION/�y' q
WELL CON]RACTOR COMPANY NAMF._14� I�LC ll,P,l� 6c t . ✓tQ PIIONE Oka 43Y-2(;,;
STATE WELL CONSTRUCTION rF:"IiT# ASSOCIATED WQ PERMIT#
(if applicable) (if opplicable)
I. WELL USE(Check Applicable Box): Residential 111'Municipal/Public❑ Indushial ❑ Agricultural❑
Nionitoring❑ Recovery ❑ heal Pump Woler Injection❑ Other❑ If Otter,List Use
2. WELL LOCATION: Topographic/Land setting
Near st�T��own: ��I Cuuuty6le c-4 � []Ridge WSlope ❑Valley ❑Plat
�
(ZCJ�L_1_ �-�'! "L_,L.' Al (check appropriate box)
(Street Name,Number,Community,Sublivki ,Lot No.,Zip('Mr) Latitude/longilude of well 0caliun
7 6 N3c°lr? f e�
3. OWNER: - 1 •I1G(� _ _ (Jearee✓minu a✓rernndr)
Address 15 7 Y-1� (AIGT(/ Laliluddlongitude source:❑GPS❑Topographic map
(Street or Route Nu.) ( (check box)
� AI C ��D b pup-I'll DRILLING LOG
City or loin Ste Zip Corte From To Formsition Description
0 - l(�' — S
Area emit,phone number I r2 ti0'
4. DATEDRILLF,DH -"CA;
5. TOTAL DEPTIL•�1.5'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Q--
7. STATIC WATER LEVEL Below"rop of casing: 'O Fr.
(Uxe"t^if Above Top of Cnxina)
8. TOP OF CASING IS�_Fr. Above Land Surface*
-Top of earrne lerminnled Wm-below Ixml xurfxce requh'er a
varrxnre In occordamt with 15A NCAC 2C.0119.
9. YIELD(gpm): r'ci METHOD GF TES'r_i1,i�—__
10. WATER ZONES(deptli):
LOCATION SKETCU 3e
11. DISINFECTION:Type i'1 LAe Amount l S Show direction and distance in miles from at Icotdj Gin
12. CASING: I Wall'i liickornx two State Roads or County Roads.Include the Ail
Urplh ) Diameter or WeighUFt, h1nln ial numbers and co anon mad names. AG
Fron(�'TOW F.I. Gj
0
Front /� To Fl. C -� j /8Y
co
�o
Flour To 1'l.
13. Ci ROL)T: Depth III )mint Method - a- a nt`
Frrnn Tom,,.'r� Fl. -Y D. s" ? a W So
From To Ft. _ n— ,
cn
14. SCREEN: Depth Diameter Slot Si'm Material n
From To Ft.—in. in.
Frcut To Ft. in. in. �L) / I
15. SAND/GRAVEL PACK:
Depth Size NL•detinl �n .
From To Ft.
From To Ft.
16. REMARKS:
IDOIIEREBYCER'rIFYTHA'r1llIS WELL WAS CONS IRUCIT?DINACCORDANCEWITH15ANCAC2C,WELL 2=
CONSTRUCTION STANDARDS,AND THAT A COPY OF I HIS RECORD HAS BEEN PROVIDED TO TIfE WELL OWNER
co
-- SIGNATUIWOI'ItiILSONCONS"IRUCIINOTIIEWELL DATE
CY
Submit the original to lire llivision or Water Qua lily,Gi omtdvvaler Section, 1636 Mall Service Center-Raleigh,NC
27699-I06 Phone No.[phone],within 30 dnys. GW-I REV,0712001 '

307330
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and`N�latural Resources-Division of Water Quality-Groundwater Section�]
WELL CONTRACTOR(INDIVIDUAL)NAME (print}%! ki, wGt" , '}�,�Is- Y �/� CERTIFICATION
WELL CONTRACTOR COMPANY NAME
vP=t�IkU.z W'tLi. "� -AWL)G1 PHONE # �r
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if licable (if a licable
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCA I �" Topographic/Lan setting
Near e Town K— r.(unty Midge ❑Slope alley ❑Flat
Y (check appropriate box)
(Street Name in ,Subdivision,Lot No.,zip Code) Latitude/longitude of well location
3. OWNER: (degrees/minutes/secunds)
Address Latitudellongitude source:❑GPS❑Topographic map
(Strect or 1 o to No.) (check box)
DEPTH DRILLING 4OG
try r of State zip Code From To Fo ati n esc 'ption
l
Area code-Phone number b
4. DATE DRILLED 2O `J�
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 2(
7. STATIC WATER LEVEL Below Top of Casing
� FT.
—
(Use"+'if Above Top of Casing) 1�'1 734
8. TOP OF CASING IS ( FT.Above Land Surface' ap
�
-Top of casing terminated atlor below land surface requires a, Cp Ol�
variance in accordance with 15A NCAC 2C.0118. m
9. YIELD(gpm): METHQD OFITEST
10.WATER ZONES(depth): SPOL LOCATION SKETCH A
v?
a
11. DISINFECTION:Type Amount Show direction and distance in miles from at le b in Cr
12. CASING: Wall Thickness two State Roads or County Roads.Include the ea9 cm'1
Depth ��rt ter �(Wa t'Ft. Mat numbers and common road names.
From_To � Ft. �yu�, ` "'
From To FL
From To Ft.
13. GROUT' Dept,_ M cipal Meth
From b To DC� Ft.
From To Ft. I `9
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. fl.�
From To Ft. in. in. O�-
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WEL
CONSTRUCTION STAND S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE LL R i -
6s 00 � -
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE I
CD
sr
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. lu.0011D 306910
North Cniolina-Depaihucnt of Enviroiunenl and Nalu I Resources-Division of Water Quality-Groundwater Section
/parr/�eGGL CERTIFICATION# 2 '
WELL CONTRACTOR(INDIVIDUAL)NAME (print) 0
f
WELL CON'TRACTOR COMPANY NAarE �7
PHONE # fA15'v Pl7".zSf�
SSOCIATED NVQ PERMIT#
STATE WELL CONS TRUCTION rF.MtITp A
if n iicnl is _ (if npplicnbic)
1. WELL USE (Check Applicable Bon): Residential ErlMunicipal/Public 0 Industrial ❑ Agricullutal❑
bfonitoring Cl Rcwvcry 0ItIle, pump Water injection❑ Other O If Other,List Use
2. WELL LOCATION: Topographic I-nnd stilling
NcmcstT0wu:_„�17✓r'D�eY County u6A.e olidge ❑Slope ❑Valley ❑Flat
l�b f' ✓!C �(�• _—___ (clink appropriate box)
location
(Street Nam Numhen,Crnnnnmity,Subdivision,Tut No.,lip Col Latitudc/lon�ilude of will
e) rW08� ��is�• �
��// (degreea/minntes/rrcnnJs)
3. OWNER: Aay,. /ivu
Address 105Lalituddlongilude source:OGPSOTopographic map
(Sneer tx R ute No.) (clink box)
u_�IL IM VV_LL(NQJ LQ_U
Zi+cotle Prom To FormalionDcscriplion
City or Town State 1
(—ie
A+rs a+ale-Phone nnn,btr
4. DATE DRILLED
5. TOTAL DEP'I IL•_
6. DOES WELL REPLACE EXISTING WELL7 YES 0 NO D'
7. SFATIC WATER LEVEL BclowTopofCnsiog:-0_Q___F'r.
(Uwe"+"If Abovelnp of Casing) -
8. TOP OF CASING IS —Fr.r.Above Land Sul face* 2
aTep of ca+ing Irnnlnated atfor below land surface requht$a N P7
variance In accordance with ISA NCAC 2C.01 Ol. -
9. YIELD(gpm):�/yi MGTI(UD OFTEST %r - o
10.WATER ZONES(depth): +/4o t OCAT10N SKETCH
I I. DISINFECTION:Type /f7`1ik Amount iy C �P Show direction and distance in miles from at Est
Wall Thickness two Stale Aoads or County Roads. Include We road
12. CASING: numbers and common road names.
pcp0i Diameter or WcighUFL'M`tciial
Prom 0 To Ft. `' fA"(
Front_ To—
From To Ft.
13. GROU'C Depth I. ale[ Method
Fron,_ D To 1F7 Ft. tZ
From 7 To R•0 Ft. 10a✓aiOcc�
14. SCREEN: Ucpdn Diameter Slot Size Material
From 1 o Pt. in, in.
Front To FL ill. ill. -
15. SAND/GRAVEL PACK:
Dcp11r Sixo Material
From ro Pt.
From F'o FL
16. REMARKS:
I DO HEREBY CERTIFY MAT TEAS WELL WAS CONSIRUCIT13 IN ACCORDANCE WITI1 I5A NCAC 2C,WELL
CONSTRUCTION STANDARDS THAT A OF THIS RECORD IIAS BEEN PROVIDED TITIIE WELL OWNER
SIGNA'rU1JlCL'J01'1'EKSON CUNS'I'RUCI'!NO TfIE WBI L di 11
DAIS
Submit the orlglnal to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
OW-1 REV. 07/2001
I7699-1636 Phone No.[phone],within 30 days.

tic ✓ WIN II? -------— HII7� -------
�vLL�, coNs rL iorr w,coxD 3 0 g 913
Nor III Carolina-Deparuncnt of ElIvilolunent and N\alural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME ol,60 )OM\N% t!, 11^ \fir^ CERTIFICATION a ,1 L���
WELL CONTRACTOR COMPANY NAME
STATE WELL CONS"IRUCf10N PEMII TOASSOCIATED WQ PE"IITa .
(ifNSntle) _ (ifapplicable)
1. WELL USE(Check Applicable Doz): Residential[�Municipal/Public❑ Industrial ❑ Agricultural❑
D1ouitoring❑ Recovery ❑ Ilea(Pump Water Injection❑ OUrer❑ ICOdret,List Uae
2. WELLLOCATION: Topografiltic/Landsetting
Nearest Town:m f l(a Comelyf h t-L. k�L-.. ❑Ridge U51ope ❑Valley []Flat
(check appropriate box)
(Sure(Nalue.Number,Community,Subdivision,Lot No.,Zip Code) Latiluddlongilude of well location/n
-
I of 8'S77"_r V S5 9
3. OWNER:J"4 1 i L " I I�0 M1'P (depeedminwea4eeonds)
Address P 0 6 o X 8 76 Latitudellongitude source:❑GPS❑Topoglaphic map
(street"Route No.) (check box)
_ OU
w a f b j a /( Z 8 go 5 — PEP'['li D soon Description
From To Formation Description
City or Town Stele Zip Code U 5 (
eC rcvde-Phone number �
Are `' `�13S
4. DATE DRILLED A (, -LJQ
5. TOTAL DEPTI I: 3Yb -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ �-
7. STATIC WATER LEVEL Below Toll ofCasiog: SL' Ir.
(Use"+"If Above Tor or Caaina) (V
8. TOP OF CASING IS t Fr.Above Land Sul lace•
•Top of erinr terndnated xt/or below lend surface requires a O
varlance In accordance with 15A NCAC 2C.0118. �]
9. YIELD(gpm): ( METHOD OF T'EST&
to.WATER ZONIS(depth): I OCA "ION KEL.-If
11. DISINFECTION:TypeL� Show direction end distance in mike from at east
�I�c l< Anwuu(
12. CASING: Wall Thickness two Slate Roads or County Roads. Include W�road
Depth Uimucter or WcighUfl. Material numbers and cot on road names. 'n
From
Flom To FL
From To FL
13. GROUT: Depth h nlenal, McUtod
From { To�3F i FL `> , ' ( P S rrCN
From To FL
14. SCREEN: DepUr Diainetcr Slot Size Material Y^e }ct Lh
Front To
From To Ft, in.
15. SAND/GRAVE).PACK:
Depth Size Material Pufl� COVe.
From To FL a
Front To Ft.
16. REMARKS:
r
I DO IIEREBY CGi"fIFY THAT I HIS WELL WAS COIJST'I(UCIED IN ACCORDANCE WITII 15A NCAC 2C,WELL "-
CONSTRUCT ION STAtJDNU)S,AND TIIAT A COPY OF TI IIS RECORD IIAS BEEN PROVIDED TO TEE WELL OWNER oli
f y itl�i�ti-�
- ---- _ <.
SIGNATURE OF PFRSON CONS"ERUCTING TIIE WELL UATE
1 rJ
Submit (he origlnal to the Division of Water Quality,Groundwater Section,1636 Mall Service Center-Rillelgh K,___.
1769 9-1 63 6 rhouc NO.[phone],tvllbhi 11) da}'s.
OW-1 REV.0712001

NC ✓ OWNER MWO
WELL CONSTRUCTION RECORD 3 6 9 2 2
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME t)(prin -Wyyt fl S ��SI fl CERTIFICATION#.2 c/d
yy�� y
WELL CONTRACTOR COMPANY NAME I'i,I)or \,Ja_ll elf" -\! PHONE # (4dfr) YSY-aG+]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(i f applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential r —1funicipal/Public❑ Industrial❑ Agricultural O
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT O TopogmphiefLand setting
Nearest Town: g(,)SCounlyC\AE6
CkA-Q ❑ C�Ridge lope ❑Valley ❑Flat
(check appropriate box)
(s Name,Numbers,Com-m�unity,Subdivision,Lot No.,Zip Code) Latitudellongitude Orwell location
3. OWNER:-nQ\/e. l 'CL (degrea/mimnes/e«onda)
Address ^'tcf Ton 4 C, tm - (PA4I r RA Latitude/longitude source:❑GPSOTopographicmap
(5 eel or Route No.) (check box)
A� �fcuts A/L_ 2-4$g0 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
�) 0 — 1 n 1
Area code-Phone number In 6 r)I
4. DATE DRILLED I- aI-Dt; /nn _ 3nn1 . e- Ni
5. TOTAL DEPTH: 3®S 1 :min tnn
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO O— r_ {
7. STATIC WATER LEVEL Below Top of Casing:
(Use"+"if Above Top of Casing) ( I.
8. TOP OF CASING IS I FT.Above Land Surface"
*Top of easing terminated at/or below land surface requires a G _
variance In accordance with ISA NCAC 2C.0116.
9. YIELD(gpm):_ 0 METHOD OF TEST_ _
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type hT Amount (S Show direction and distance in miles from at least
12. CASING: Wall"Ildckness two Stale Roads or County Roads.Include the road
Depth Diarneter or Weight/ht. Material numbers and common road names.
From O To fins-L FL c,
From To Ft.
From To FL
13. GROUT: Depth Mae al Methodm Fro n To ,2 ' Ft. r�,�4o11`,�r Pz-ss,.s,•
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. I p
Front _To_Ft. in. tort
15. SAND/GRAVEL PACK: in, d �o ;cE
w�rrSvt/�
Depth Size Material pd'�
From "ro Ft. -
From To Ft.
16, REMARKS:
I DO 1(ERrBY CERTIFY THATTIHS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C,WELL n
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER .,
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE c°
o '-
Submit the original to llte Division of Water Qualify,Groundwater Section,1636 Mall Service Center-Raleigh,NC_ o
27699-16..16 Phone No.[phone],within 30 days. OW-1 REV.07/2001'„
t

WELL CONSTRUCTION RECORD 306771
North Carolina Department of Environment and Natural Resources-Division of Water Quality.
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVIDF.MCKINNON CERTIFICATION N 2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE N (828)837.8me
STATE WELL CONSTRUCTION PERMrTN ASSOCIATED WQ PERMITN
(if appicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential;;] Mimicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:MURPHY County CHEROKEE
)❑Ridge ❑Slope ❑Valley []Flat
547 PRIVACY RIDGE LANE (check appropriate box)
(street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: SHANNON HELTON
(degsexs/matuta/seconds)
Address 641 SHADY GROVE RD Latitude/longitude source:❑GPS❑Topographic leap
(Street or Rout.No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City in Town stale Zip Code From TO Formation Description
8( 28 } 835-7411 0'TO 5' RED DIRT
Am codo-Phone number 5'TO10' SANDSTONE
4. DATE DRILLED 01-07-2005 10'TO 30' GRANITE/MARBLE
5. TOTAL DEPTH: 807' 30'TO 807' GRANITEIMARBLE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 236 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surfaces
•Top or casing terminated atlor below land surface requires a
variance In accordance with 15A NCAC 2C.8118.
9. YIELD(gpm): 0 METHOD OF TEST AIR
10. WATER ZONES(dtpth):
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 30 Ft. 61/8" SUR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method y�VHI
From 0 To 20 Ft.CEMENT GRAVITYFrom To Ft. �
14. SCREEN meter Sl
: Depth Diaot Size Material
From To Ft. in. in.
lY From To Ft in in.
15. SANOGRAVEL PACK:
Depth Sin Material
From To FL
From To Ft.
16. REMARKS:WELL WAS HYDROFRACTURED.YIELD-3 GPM
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND
/THAT
r�ACO',/1pY OF HIS RECOR HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. --
GW-I REV.09/2004.-

WELL CONSTRUCTION RECORD �
North Carolina Department of Environment and Natural Resources-Division of Water Quality 307034
WELL CONTRACTOR(INDIVIDUAL)NAME (prkq DAVID F.MCKINNON CERTIFICATION 2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE N (8281837-M8
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential13 Mutdcipal/Public❑ Industrial❑ Agriculttlml❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE )❑Ridge ❑Slope ❑Valley ❑Fiat
HARSHAW RD NEAR LITTLE BRASSTOWN CHURCH (chock appropriate box)
(Strut Name,bi mben,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: TED COOK (degrees/minnte✓seconda)
Address 1395 HWY 64 WEST Latitude/longitude solace:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTI DRILLING LOG
City or Town state Zip Code From To Formation Description
8(_28), 837-7491 0'TO 50' RED DIRT
Areas code-Phone number 50'TO 60' SANDSTONE
4. DATE DRILLED 0110312005 60'TO 81' BLUE SLATE
5. TOTAL DEPTH: 405' 8V TO 360' BLUE SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑ 360'TO 362' GARNETT
7. STATIC WATER LEVEL Below Top of Casing: 50 FT. 362'TO 405' BLUE SLATE
(Use"+"if Above Top of Casing) m ,
S. TOP OF CASING IS 1 FT.Above Land Surface'
'Top of caring terminated nVor below land surface requires a
variance in accordance with 15A NCAC 2C.01It
9. YIELD(gpm): 5 METHOD OF TEST AIR
10. WATER ZONES(depth): 9T BIT SIZE 6.113
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from throad
least -.
12. CASING: Wall Thickness two State Roads or County Roads.include
Depth Diameter or Weight/Ft Material numbers and common road names.
From 0 To 81 Ft. 61I87 SDR 21 PVC
From To Ft. L/c-.�
From To Ft. y
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT GRAVITY 47
From To FL
14. SCREEN: Depth Diameter Slot Size Material 1
From To Ft.—in.
From To Ft. in in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. SL
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THATA COPY.91i THIS RECORD 1Z PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON coNTrRUCIING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
('iW-1 REV.09/2D04

��/ 307035
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVID F.MCKINNON CERTIFICATION('2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE# f 628)837.8008
STATE WELL CONSTRUCTION PERMff# ASSOCIATED WQPERMff#
if applicable) (if applicable) _
1. WELL USE(Check Applicable Box):Residential h] MunicipaWublie❑ Industrial❑ Agriculhral❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:MURPHY County CHEROKEE )❑Ridge ❑Slope ❑Valley ❑Flat
173 HILLS&HOLLOWS (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudc/longitude of well location
3500.591 N18405.557W
3. OWNER: WALTER MOELLER/CATHERINE BIFFONI (degroea/minutes/seconds)
Address 173 HILLS&HOLLOWS Latitude/longitude sotrce)OGPS❑Topographic map
(Street or Rome No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town state Zip code From To Formation Description
(828)-837-1281 0'TO 40' BROWN DIRT
Area code-Phone number 40'TO 60' SLATE
4, DATE DRILLED 01/19/2005 60'TO 75' BROWN DIRT
5. TOTAL DEPTH: 485' 75'TO 200' BLUE SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑ 200'TO 46041 GRANITE
7. STATIC WATER LEVEL Below Top of Casing: 100 FT. 460'TO 485' GRANITE&MARBLE
(Use"+"if Above Top of Casing) '
S. TOP OF CASING IS I FT.Above Land Surface*
`Top of casing terminated Wor below land surface requires a
variance in accordance with ISA NCAC 2C.01I&
9. YIELD(gpm): 12 METHOD OF TEST AIR co
10.WATER ZONES(depth): 350'-1 GPM 429-1 GPM.46T-10 GPM
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles fromgtleast
12. CASING: Wall Thickness two State Roads or County Roads.Include road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 97 Ft. 6 IW SDR 21 PVC
From To FL
From To FL
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 Sim Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRU 1O STAN) S,ANQ,-THAT A COPY F THIS HAS BEEN PROVIDED TO THE/W/ LL70 NER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone Na(919)733-7015,within 30 days.
OW-1'REV'.09/2004-

WELL CONSTRUCTION RECORD 307686
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVID F.MCKINNON CERTIFICATION a 2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PIIONE 4 [phone]
STATE WELL CONSTRUCTION PER MITO ASSOCIATED W V PERMI'f8
(if applicable) if applicable)
I. WELL USE(Check Applicable Box):Residential1l Mtnicipal/Publie❑ Industrial❑ Agrictdtlual❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE )❑Ridge ❑Slope ❑Valley []Flat
BRASSTOWN-MASON MTN(ON TOP) (check appropriate box)
(Street Name,Nmnber,,Community,Subdivision.Lot No-Zip Code) I.alitude/longitude of well location
3. OWNER: PETE BURCH (degree,/minutes/seconds)
Address 15O VERONICA LN Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPlTi DRILLING LOG
Citv or Tow. State Zip Code From To Formation Description
(828 - 837-0627 D'TO 70' BROWN DIRT
Area code-Phone number 70 TO 85' GRANITE
4. DATE DRILLED 02117/2005 85'TO 500' GRANITE
5. 'to rAL DEPTH: 805' 500'TO 540' GRANITEIMARBLE MIX
6, DOES WELL REPLACE.EXISTING WELL? YES❑ NO ❑ 540'TO 805' GRANITE
7. STATIC WATER LFVEI,Below Top of Casing: 250 FI.
(Use"+"if Above Top of Casing) CCii -
8. '1 OP OF CASING IS I FT.Above Land Surface• to
'Top of casing lerminaled al/or below land surface requires a M .{
variance In accordance will,ISA NCAC 2C.0119
9. YIEI,D(gpm): 113 METHOD OF TEST AIR
10. WATFR ZONES(depth): co
LOCATION SKETCH OO
11. DISINFECTION:Type CHLORINE Amotmt 100 PPM Show direction and distance in miles from asast
12. CASING: Wall Thickness two Stale Roads or County Roads.Include the road
Depth Diameter or WeighUFt- Material numbers and common road names.
From +1 To 85 FL 6118" SDR 21 PVC
From To Ft.
R
From To Ft. - — - cyv L
13. GROUr: Depth Material Method �/ er
From 0 To 2D FL CEMENT _GRAVITY v, 1
From To Ft. �""�
14. SCREEN: Depth Diameter Slot Size Material , ,
From To Ft. in. in. K,
From 'to Ft, in. in ?tr
15. SAND/GRAVEL PACK.
Depth SiZC Material
P
From to Pt' --------- .; � .�__----�_
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS RIIC'I-ED IN ACCORDANCE WfH115A NCAC 2C.WELL
CONSTRUCTION STANDARDS,AND THAT FACOPY�W I l lIS RECORD IIAS M l N I ROVIDED 1011117 WELL OWNER
7 - u
SIGNATURE OF PERSON 61- STR CTINGTHEWELL DATE.
Submit the original to the Division of Water Quality,Attn: Information Management,1.417 N}ai1 Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004
'ti'.'.', _,_ _

V�
WELL CONSTRUCTION RECORD 307685
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVIDF.MCKINNON CERTIFICATION02411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
1. WELL,USE(Check Applicable Box):Residential XI MimicipaL/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land selling
Nearest Town: MtAtl_FIT JL- County CHEROKEE ❑Ridge ❑Slope ❑Valley )❑Flat
BOURNE DR TO BLACKBERRY BEND (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: LORALYNNE SCHNEIDER (degrees/mmum/acconds)
Address 3419 FARMSTEAD DR Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
i.h'S rM1 11
ISiN2 MD 21157 DEP'I'H DRILLING LOG
city or Town slate Zip Code From 'I'o Formation Description
(443 }465-8514 0'TO 20' RED DIRT
Area code-Phone number 20'TO 100' SANDSTONE
4. DATE DRILLED 02/10/2006 100'TO 110' BLUE SLATE
5. TOTAL DEPTH: 305' 110'TO 115' LOOSE MATERIAL/DIRT
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO I3L 115-TO 135' BLUE SLATE
7. STATIC WATER LEVEL,Below Top of Casing: 50 F1'. 135'TO 305' BLUE SLATE
(Use'W'if Above Tnp of Casing)
8. TOP OF CASING IS I FT.Above Land Surface`
•Top of casing terminated iUur below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 12 METHOD OF TEST AIR
10. WATER ZONES(depth): 220',2W BIT SIZE-6.010
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or WeighVFt. Material numbers and common road names.
From 41 To 134 Ft. 61/8- 3DR 21 PVC �2
From "ro Ft. P4
From To Ft. �1
rn
13. GROUT: Depth Material Method W {)
From 0 To 20 Ft,CEMENT GRAVITY
From To FL - l��
co
14. SCREEN: Depth Diameter Slot Size Material t CC:)
From To Ft. in. in. 1` _ .PA'ltn,,.(=b ----_ -
From To Ft. in. in.
15. SAND/GRAVEL PACK: Q�
Depth Size Material
From To Ft.
From "fo Ft. -y
16. REMARKS:
I DO HEREBY CERTIFY TIIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY O THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CO S"FR(CTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: information Management,1617 Mall Servitore"ter-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2W4

WELL CONSTRUCTION RECORD 3 0 7 6 8 4
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDI JAL)NAME (print) DAVIDF.MCKINNON CERTIFICATION 2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential.[] Mtmicipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ if Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest'fown: MURPHY County CHEROKEE ❑Ridge ❑Slope ❑Valley )[]Flat
WHITE OAK FOREST (cheek appropriate box) -n {
(Sircet Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Ldlilude/longilude of Well location Cp 0
te
3- OWNER: STEVE CROWE (degrees/minutes/seconds)
Address 5510 HWY 64 WEST Latilude/longitude source:❑GPS❑Topogmphemal,
(Street or Route No_) (check hoc) (.A
MURPHY NCM 28906 DEP'ftt DRILLING LOG i
City or Town State Zip Code From To Formation Description
(828 ). 837-9199 0'TO 80' RED DIRT
Area code-Phone number 80'TO 120' RED DIRTISANDSTONE
4. DATE DRILLED 0*12005 120'TO 155' SANDSTONE
5. TOTAL DEPTH: 606 155'TO 181' BLUE SLATE
6. DOES WELL REPLACE,EXISTING WELL? YES ❑ NO Vk 181'TO 605' BLUE SLATE
7. STATIC WATER LEVEL.Below Top of Casing: 456 FT.
(Use"+"if Abme lop of Casing)
S. TOP OF CASING IS 1 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): --- METHOD OF TEST AIR
10. WATER ZONES(depth):
LOCATION SKETCH
I I. DISINFECTION:Tvpe CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the mad
Depth Diameter or Weight/Ft. Material nlunbers and common road names.
From +1 To 180 Ft. 6Its- SUR 21 _PVC
From "fo FL Ly,
From To Ft.
IA GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY
From To Ft.
14. SCREEN: Dc th Diameter Slot Size Material
From "fo Ft. in. in.
Prom To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From "I'o Fl.
From 1'o Ft
16. REMARKS:
I DO BE'REBY CERTIFY THAT"THIS WELL WAS CONSIRUC FED IN ACCORDANCE WI111 15A NCAC 2C.WELL
CONSTRIJC I ION STANDARDS.AND THAT A COPY OF 1lIkRECORD HAS 13L�FN PROVIDED TO THE WELL OWNER
1 l
SIGNATURE OF PERSON CONSTRUCTING THE WEI.L DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service_Center-
Raleigh,NC 27699-1617, Phone No.[phone],Within 30 days.
GW-1 REV.09/2004

11"
WELL CONSTRUCTION RECORD 3 0 ? 8 7 Q
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIIADUAL)NAME (prrri//nt) r-ra K,N Z- P tI I LTA(Z CERTMCATION#ion 175
WELL CONTRACTOR COMPANY NAME �V�=�.S wLL"�- �fZI(�111Co �IVC. PHONE 7Y 5'z166
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if avDiivable ifapplicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATIOqN: Topogra dLand setting
Nearest Town: 1W421262'WS County Ck- OZo EL ❑Ridge IRSIope [Walley ❑Flat
.okbs atAy T89a/ (check appropriate box)
(,street Name.Numbers,Cw,mu City,Subdivision,Lot No.,tip Code) Latitude longitude of wel logati n
�, jf35°/L� X33' (�c83eM e7?
3. OWNER:0QVf D 6aU tv1 c?\1 tJ (degrees/mimneslsaonds)
Address 4S LO205 way Latitude/longitude source:❑GPS❑Topogmphicmap
("NE
Sweet or Route No.) (check box)
AN oo� $ N G 2 g?o l DEPTH DRILLING LOG
City or Town �srate Zip Code From To Formation Description
3 Z I - y9-&;l G Z 82a,.r t
Area code-Phone number ,aa-E� Ltk`171f&?Ld Ark
4. DATE DRILLED 2 -i - O 6 �� 4 Ad) /f�c o/��
5. TOTAL DEPTH: i A S r 29 3 G/ nF SIsT _
6. DOES WELL REPLACE EXISTING WELL? YESO EJ
7. STATIC WATER LEVEL Below Top of Casing: .
(Use"+"ifAbow Top of Casing)
S. TOP OF CASING IS FT.Above Land Surfaces
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0119.
9. YIELD(Spun): A9 METHOD OF TEST
10.WATER ZONES(depth): /z�2 5-4 19 -2 Yy'
LOCATION SKETCH
11. DISINFECTION:Type / Amount V O'Z Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft al numbers and common road names. as
From Z To i? Ft .�27 5 y L ZrIC-)
From 9 To74 Ft� 3a� �� " "'m
From To Ft �rrn
13. GROUT: Depth Material Method o�
From O To2.—QFt CG-M&4r- -to
From To Ft
14. SCREEN: Depth Diameter Slot Size Material oQ
z:
From To Ft in. in.
From Tc Ft in. in. �
15. SAND/GRAVEL PACK
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTIONS,�ARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27 69 9-1 63 6 Phone No.[phone],within 30 days. GW-1 REV.0712001

NC _� OWNLR — — MWO
WELL CONSTRUCTION RECORD 3 p g 16 3
North Carolina-Department OT Envilonnnenl and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME Owln1• � y^A' ps �� ��t\50(1 CER'rIFICATIONM 9yov
WELL CONTRACTOR COMPANY NAME WII IIP C r A�N�� Acl kl+,t')a FnoNE a [*sx�1 ts37-��iry .
STATE WELL CONSTRUCTION rERa11"1M ASSOCIATED WQ 1'ERMITM
(ifapplicnble) (ifapplicablc)_ - ---
1. WELL USE(Check Applicable Box): Residential 1111 unicipal/Public O Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Ilea(Pump Water Injection O Other❑ If Other,List Use
2. WELL LOCATION: � TopographictLand sylting n
Nearest Tor (� t 1 /� Count • P— ❑Ridge OSlope �ellcy OFlal
Al t CLe-e--co m. (chmk appropriate box)
(--reel gang,Numbers,C nmunhy.suklivision,Int NO.,lip(AMIe) Latitudr/longitude of well location
3. O W NI-,It:Zr/tC,ad _r_L�.- ,k,✓� __ (depeedminnteJesnnds)
Address .�LE 6-ra c p A 6A � Laliludc/longitude sowce:OGPSOTopogiapIlic map
(Sheet or Route No.) 111 t (check box) 1 ' ] 1
YS;m P.I].rlaielLl2.1aQ(1
City or t wn Siae z+r 0ale Front '1'o Formation Description
Am mlc rhane mmtber -
4. DATE DRILLED®
5. TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES L) NO
7. STATIC WATER LEVEL Below'l'op of Casing: '
(Use"e"if Above I up of Cxeinit)
8. TOP OF CASING IS—1_—_FI'. Above Land Surface'
•Tap of rasing rrrminabd al/ar brlan land u.rkre regnlrn a
rarlante Iw accordance with 15A NCAC IC.011a.
9. YIELD(grill):_0 METHOD OF l'FS'f A
10.WATER ZONES(dcp(h):
j,(�A1'ION S>�1j
Show direction and distance in miles from at least
1l. DISINI'LCI'ION:'1'ype !? Anurtnd�� two Stale Roads or County Roads. Include the road
12. CASING: Walll hirkoess
Dcplll Diameter of Wright/Ft. Mri erial nuunbet9 and common road names.
Front�_'fo Il_1D• -ta �yr
Front -To Fl.
Front 'To Ft. _
13. GROUT: Dcplll hnenai hlcrhod JO� �POI^��
Front_To__a Ft. -
Frorn T•r_ fi_1't. �`—SI¢.'�L`r- it t
14. SCREEN: Dcplll Diameter Sint Size Material jO
Front To Ft. in.
Front__Tv FT in. in. x
15. SAND/GRAVEL PACK: p(v
Depth Size hlatrlial
From To Ft.
From fo Fl. _
16. REMARKS:
1 DO I IFRFEY CFR"riFS'7llAT Tli1S WELL WAS CONSTRUCITD IN ACCORDANCE Willi 15ANCAC 2C,WELL
CO INSTRUCTION S"fANDARDS,AND TIIAT A COPY OF"IIIIS RECORD HAS BEEN PROVIDED TOTHE WELL OWNER
SIGNATURE01:PERSON CONS1RUCHNO THE WELL DATE
Submit the original to tire Division of Water Qn slity,Groundwater Section,1636 Mall Service Center-Raleigh,NC
27699-1636 rhooe No.[phone],within 30 dnys. OW-1 REV.07/2001 {/

NC >/ OWNER — --- MWO
WELL CONSTRUC• IONAECORD 0 816 2
Not lh Carolina-Department of Envirrnuneut and Natural Resources-Division of Water Quality-Groundwater Section
WELL CON TRACIOR(INDIVIDUAL)NAME (print) I-AAm � W,\ Sin>n CERTIFICATION/ay04 WELL CONTRACTOR COMPANY NAME Y v\r 1'Q-r lh7'Q� C i,'• !iV PHONE P f Kale) -
STATE WELL CONSSrRUCL1ON rE.M11TM ASSOCIATED WQ PERMITM
(if nppFcable) (if applicable) ---
rIt�I0rO.1
I. WELL USE(Check Applicable Box): Residential 10,--Municipal/Public❑ Industrial❑ Agricullural❑
Monitoring❑ Recovery ❑ ❑cat Puntp Water Injection❑ Other❑ If Oilier,List Use
n
2. WELLLOCATION: -rI
nn II� --�� II,, __ Topographic/Land setting
Neared Town:)_Y) Cuuill)'l �em- -1 Midge ❑Slope LIIWRflcy ❑Plat
aain� excl.-PT _ _ _ (check appropriate box) -
(Saeet Name•Number,,Community,Subdivision,Lan No.,Zip Gavle) LatiluJdlongilude of well location
-. O W N F R: �AnO ____ (Ae¢ee✓,ninutea ee nail:)
Address 4.Gg ..)`jt15C�`_ Laliludc/lougin,desource:❑GPS❑Topograp tic map -
(Soeel or Ruute No.) (check box)
—�1
I r EMI l2RILLIN_Si1_QSi
City orlo n Sure Zip Code From 'fo Formation Description
At"coio-Phone number /
4. DATE DRILLED 1 ._ a`7- b4i
5. TOTAL DEPTH:_—` 1 __
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO W--
7. STATIC WATER LEVEL Bclow Top of Cnsiog: ID Yr.
(Use"r"if Above Top of Celina)
8, TOP OF CASING IS 171'.Above Land Surfacc•
•Top of mint Irrml-M,el aUor below land mrrace requires a
v Hanet In accordance with 15A NCAC I47.0110. IR
9. YIELD(gpnl): L4fZ_ML•TIIOD OF'Il: l' �-
10.WATER ZONES(dep(h):
_ LOCATION SKETCI<
11. DISINFECTION:Type Amnuld_I r Show direction and distance in miles from at [cast
12. CASING: Wall Thickness two Slate Roads or County Roads.Include the 6iJ ..
Depth Diameter or WcigbUFt. M Imial numbers and common road names. r�
rron(_6 Dr To Y FL (o, 0 t� .��ee1 1�
From To FI.
From To Ft.
13. GROUT: Depth MRIcIiRt ethod
Fron(_ To 9m/ Ft.
2n�pn��P -1- 'QrZ[�Ifanr�
Rom To Ft.__ ----
14. SCREEN: Depth Dimncler Slut Sizc Material �`�pp(" u1-1-iN5
Front To Pl.—in. in. S` cfc'e-k
From__To__Ft. in. in.
15. SAND/GRAVEL PACK: p3
Depth Sizc l4atctial
Front To FI.
Front ro Ft.
J-
16. REMARKS:
D0 I lFRF.BY C:RTIFY'I I IAT THIS WELL WAS CONS I ROCI ED IN ACCORDANCE Willi 15A NCAC 2C,WELL
CONSTRUCT WN STANDARIIS,AND THAT A COPY OF 71llS RECORD HAS BEEN PROVIDED TO TILL,WELL OWNER
SI(iNATU1U!OF 1'I RSUN C'ONS7RUCIING TIIB WELL DAIL
Submit the orii;inal to the Lllvislon of Water Quality,Groundwater Section, 1636 Mail Service Center-Raleigh,NC
27690.1636 Phone No.[phone],within 39(Init. GW-I REV.07/2001

NC V OWNER MWD
WELL CONSTRUCTION RECORD 3 0 815 �
North Carolina-Department of Environment mid Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print) .,ONyl" R t w71154/� CERTIFICATION#-NO
WELL CONTRACTOR COMPANY NAME IM III P_r tApiP,� Ar-A',vtg4 PHONE 0 (klD(ZT7-1CY4
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# -
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box): Residential 01�--k4unicipal/Public❑ Industrial❑ Agricultural❑ _
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic(Land setting
Nearest Town:MuaW I County0A Lop #Ridge ❑Slope aWialley ❑Flat -
1 P r p P (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) L8Illnde/lORgltade Of Well location
3. OWNER: / (/fi Durck (degreee/mimdes/secondc)
Address Latitudellongitude source:OGPS❑Topographic map
(Street or Route No.) (check box)
DEPTH DRILLING LOG
City or Town State Zip Cale From To Formation Desert Lion
Am code-Phone number Ib t..l,�s _
4. DATE DRILLED Q- 15- FPS
5. TOTAL DEPTH: ClaIV A
6. DOES WELL REPLACE EXISTING WELL? YES O NO U— 5
7. STATIC WATER LEVEL Below Top of Casing:—50+ FF. g
Z
(Use"*"if Above Top of Caring) D
g. TOP OF CASING IS I Fr.Above Land Surface•
'Top orening terminated al/or below land surface requires a
varlance In accordance with ISA NCAC 2C.0118
9. YIELD(gpm): I METHOD OF TEST AA,rz
10. WATER ZONES(depth): Ln
LOCATION SKETCH
II. DISINFECTION:Type Amount (< Show direction and distance in miles from at least
12. CASING: T—Wall Thickness two State Roads or County Roads. Include the tom
tL--D_Depth Diameter or FVcigln/FC M, Plet numbers and common mad amen.
Fror To Ft t 1 �- ,StL l ,
From To Ft. \SY Cr
From To Fl. °f
13. GROUT: Depth �, �,aterin{ I 1 Method R2
From TO aLl rt.?0= 1. �, kcrA-AT e-
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material d
From To Ft. in. in.
From To Ft. in. in. .\ Rd 2014
15. SAND/GRAVEL PACK: \1
Depth Size Material
From To Ft.
4
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15ANCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
` SIGNATURE UP PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-16-111 Phone No.[phone],within 30 days. GW-1 REV.07/2001

1lIIlll li NIIU
Jui l,L CUNS'I7tUCT1QN REC010
14o1111 Cntolinn - Drl+allnlcnt of liuvitcittuleul will N_ntulnl Resomml- Div ision of Wnlet Quality- 0io utd,valer Scctiun
Ilnl •\S4.h—_— 'Crit I Ir IC-A-WIN 42AI8(Q
IN,FI.I,CIJNI It A CIO It(IN IJ I\'I 0I IA L)NADI E 11' )-_ 1 `v-�—''�� PNUNr, n f$ _!
IN FI A,CON I IIAC I O It CmIrAN1'N A RIE_nA
A551.ICIA"IF.11\VI)I'Fltwt110
$rA 1 F.\\'FI,1,CNNs i lolC1l0N I'F:ILri117 M_--.-_._._...---- if n, dicnblc 11
iI n , Jic;[I'll'
I, 1Vl'1.1,USL'. (l'bcck Applicnblc Itoz): Rcsidrulinl 11J/hluuicipal/1'1114ic U 11011SIlial U Altdcullulnl U v
hlotlitvl ing u Itccovcly LI I feat 1'ungr 1Vnln Injcclioll u Othcl 11 If 011icr, List I1sc --�—
` fupogrnphil/I,mld xllinp co
IJcalc<l'funm51V1tK �t ('nmu}'_ y Ca ultidgo (^18f,pc LlVallry. ullal CD
(chr[k npprr pnnlr hnr)
1owSL��lI, i�Chs4 cs — - Lnlituddlongiluleofvcclllotalmn
(Swrr11 nu,r,IJumhr,n,Conu,nmllr,Sa6Jivaion I 1 Iin.,lip Crvlr)
Laliuulc/Ivugiludc suwce.u(ip51_Ifopoglal,hicmecp
Addles _45he4-Sc(.N_+---�L-------- (check 1-,.)
(Sheet„,�I//m,nleIIm) 6 iILI!III Ullil.hlliu_imu
--_AA/�/� �/ N- $U Iunn 'I'o 1°otulation Denclipliull
_11c��1—"$lntr lip CnQr__.--._--- 1
III„' l
Nrn n-L. rh+mr nnmbcr �• `gip
d. I1n1F.. 111(IL11'.I1 —
(. I)OL•S IVI'1.1, ILEI'I,AI'It I'.\ISll1Jl) 1V141.IJ 1'Ii5 L-I NO I ---i --
7. S fr\71C 1VAlliIL LL'sVlil. Ilclo,v'I' )p of C'asiugt
-(Llrr"r"Ir At,.rvr'1-11, l'n•.inpl
R. '101' (117 CASINO IS FL Above Lnnd Smfilce, _ —
•l rp rl[nlnp In vJnnlnl nlLn Lrinv In„d an lore Ir�lnh rr
n,ln,[r In•cr,ndnncr,r'llh 15A NCAC 1C.III In, —
o. (ppl,r): t 11i1IIUU UF1Ii Sf_� _ fn
—
Il). WA'IBR TIMES (dcptlQ: rOLLC)I
De Alln,an�_ 15 Show dilcclion rind distance in miles III Of"
nt All
s1
It. [)ISINlliC110tJ:'I'ypc� two Stale Road urCounly Roads. Include Ilse toad
12. CASING: W:1111 bit knccs
Vgt1I Uimncicr or Wcigli ft, hhdelial uulnbcls and a nuuon road ualncs,
so�al
I-10111 1.0 n. __--
(lull,_ 'ho_ 1'1.----- —'-- -------
tle tb hlnlclial hlclbod
13. GItOUI': I,aor
I-lom.�_—'fo ft. tti��'So 11 SASS C
--
14- SCRPL•LI: Ncp111 Uimncicr Shl,Sin Matainl
liollt _ TO I1. in. in. ---- a�rCB •..;e.
15. SAN111GRAVI'I.PACK_
I)cI'll Si,e hb,lclinl y I 1 ,
Fidel lb I'l — ---------- {
bU _
IG. Illil.lARI:S: --
Dll III'GI'h1'CI:I!1II71'I IlA'1'1Ill I Vr'11,I,WAS('UIJS I MICI141) IN ACCORDANCE W1111 15A IJCAC 2C,1VI?I.L
CONS I RUCI II 14,S 1 ANDARUS,Alit)'1I IA I'A COPY OF'111I5 RECORD 11AS I)EL141'ItOVIDIID-1011IL WELL 01V1IE R
SWIJAI1,11M UI' I'f.RSO14 C0I4S-17IUCIINU'11114 WeLL UAII.
ubmit Ihr of Il;lu tl lu the Dh Won of 11'wlrr 1)uslilp (:unnultvnlcr Sec(lout 1616 QInllScn4ce(-(�IVrI IlFV�071211g1

wELL CONSTRU CTLO N IQr CO RD
NIal6 0au+linn - I Iri'm IIIIC 141'nvi,1)m11rnl and 11111mal Itcsolliml- Division of wMel tpndity- Olouudv;nlrl ^,rclitm
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it n • licdd•' . . .
1. \1'PI I. I IS (llr"rb, Aigdic;,I,Ic Owl). Rrr:idrnlinI I�NunicilmI/Public I_I IndushiPl I 1 Al;licullmnl U
t,L'nilnlilly I.I BCroa'rly I.I Ilent I'ongr Wnlrl hljrchun I othel I If 001cl,List
/ 'Lulnlgngdli /Enid sclliuit
Z, ll'PILIIWAIR0- c / ee_
ticurdloo.n' �/v/ y 1'ounl}' hems-O/Z_.. _ Llltidyc Ll;lopc IIVPIIry I111:11
(rhnk nhlnrq,6np hrr.)
-. I,,,lilud5/lunKdndc cr)f,crll lnc�li,+n
ISU-•1 Ilnne,I lvnd•-n,Il.nnmmil,l!:ubrGcisir.n•1•�I 1 L.,i;y 1',.Ir) O�llU�� GOFJ �� �I �__ -
y.�s
(drp,rrnlminr,l.n'c nrlQ
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UIt11.L1111,i LOI;
I IISh.IIL -
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a Ir,\Irnlnllrn_ 3o3-as__ - _ _
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7. �IAI11_ - --
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.olnrrr 1, .crm Ju,r<nino 15,% N( AI. 11 IP O —
�. �'ull,tll ,llr -5I lIiuu":, II ',I . -- - - - -- -- �„
n). 1t'n l ERi t IIJI'S (depth) 330 -- -- -- — tz( A, IuN br l 1 t;l l
1lf —ANlr,lrni jfG _ _ Shmv di rection and distance in miles lion tit Lan
it. IIISIN1T.tA l(lil: l}pc_1/_. _ -_----- Iwo Slntc Roads or Couldy Ronda blclud^ the nad
Z. l'1\SllJl is \V:di l hi4nr a
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1.1. ,rt'lilipti: Ilrplh Ul�n,rlc, InlSi;r L1alr,inl
---
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II`III111!PIt'i 011! ---
ill V IIIAI IIIIS1b'fl.l•1VA':('IliKill!ticlF1) Ill ACCORDAIICE'IVIIII15MICACA'.WFI.L
CUNS1 RUl"I tl)t! S FAIJIIAI!D:i,AND'111�1111'i t tl I111 , it U)IlD IIAS Ill;lai PItOVIUIiU'1U'11IL• V✓lil I.O\' I Ili
lt
- - -- - - - -
SIUIIAIUplull'Ill:Ii'iUtll ()F7511!UL.IINO'1 Ill!WELL I,AII.
Submit Ihr n,l);Ilr,l Io Ihr IH,idon u1 11•:It(I I hlalily,l:unwdlrnlcr Scc11(nl, I(.16111n11 tics lice(*"Ile'l I!I!V'I(I1/)(IIII I

tilt))) )? �Klj !Jill)
WELL CONSTRUCTION RECORD
I401111 Cnlolina -Drpallnlcl:t of Envirooulcol poll Nnlulal Itcsoulces-Diviniuu of WatcI Quality- Ol till lid tvnlet ScclioIt
/J 'celulrrcnrloNn ."Z 0.3
it FLI,CON i IIACI Olt(INOIFIIIIIAI.)NADI F.
\r r.IA,CON I I(A C1011 t-ODI I'ANY NANIF. _�LIL----- - ----
ASSOCIAIF.It WI)rEllp117N
51-A1 E\1F.1.1,CONS I IIOCI ION I'Eltpil7N__________._------- if n r dicnhlc
I, \Cfl 1,USE 1l'hr(k Applicable NUx): Ilesidrlllial 1-1*�Mhulicipal/Public U Indushinl U Altticulluln)U
Rloniloting U Itccovcly LI I Ica) I'unpl 1Vulrr hljection U Other U If Olhcr, List Usc
2, tVlfl.l, I OCAl1U11: Ibpn(rpphi(ll.ond .^`chilly;
IJcalcsl'Luw]I— Comdy_C/G_�o-xe URidge lIslope Malley Ul lat
(nc�rk npplrgninl�F.It)
1� 6Ju- ---- - - - - I-miluddlongitude of well lUcnlinn
(Sbrcl Nmnf,IJumLf,.•(Pnlllllllllll'.SIII•III11t1011•I OI NM1r 7III C-Ar) —_
/ o plrpttrdu,hnnrdt�'nn•I.)
�----� ��-- Laliludc/lungiludcsow cc:Ll(TSUfopoglapbicnlap
Addlres ._._Q1 ) K . .-. ----- (,beck hl.)
(,^•urrl nr a.`.Ile Ili,) L1ltILLI I O LIDO
,1 unalion IJ csaiptiun
—_ ! /slelr 711, 0, Flomill
" Eo
To
Cily ar lm,n .
Nrn rill.•- l•Imnr nnmbB —0-- G�py/i � ,_;y
a. DA11:, DRNIp•1,3 -30 -03
5.
C. Dl-IP.S NNIFLI, Riil'LACE P\IS-I IIJU WI'.I.I," Y6S LI IJO W v
7. S I'A I IC WA I ER EVI:1, Below'fup of('using __6� -1 1•
L � f
� (ll.e"F"If Abnvr l.q`of I'nriupl
()1' CASING IS �2_.-__ I-f. Above I.nnd Sul@Ice' „�-
•Inr nl<rdnp Irnnln nlyd nl/�a LAav Irud un lnrr Irqub rr• — — 0
e,imrr In teem du,tt nllb IRA NCAC 1C Ill Ifl.
9. vn7.n 1PpII1): __S U—hIF,I IIUD 01"IIiS I'-A - - ---
WA I UR ZONES 017011): `��---_-_---
_--_ Alla,ulll-. t`o�- Show Jirccliun and distance is ulilcs Gom nl Icasl
11. NIS)IJf)iCIlU1J:'I'ypc two Stale Roads or Comity Roalll. Include the rond
12, CASING: \V:dl'Ihickncss
1\,pill Dimncirr or WcighUl L Atntclinl slumbers rind commull told Ifalllcs. Emk/my/W.
I:I f-�s S tj7� /9UG
lion) /) To J' _
1'un❑ 'fo
------
t. GROU f: 1\rplll Inls1 +I ,)hull
d Tn �e n,�//t4�� �rure
I non -- -- - -
Ilonl_ _'fo
A
Id. SCREL•N; Dridh IJinulelcr IuI Sim pinlclinl m -
in.
I'nan lo-----11' in., in. - -.
--.- —
15. SANDIGRAVPI. PACK: w
ItrpUl Sire Rlnlclinl
Ilol❑ fo—_ 11.---- -- ---- - csl
Ilonl
16. RI:r.IARI:S:
Dll III REIN('ER11fY 111AT11111",WUH,WAS('01IS I I(lJCi FI)It ACCORDANCE WI111 15A IICAC 2C,NVEL .
CONS I RUCI IOIJ S FANDARDS,AND-111IA f A COPY 01:TIIIS ItECORD HAS BEEN PROVIDED TO TI ILI WELL O WI IER
� -31/-OJ-
"" . : _
SIONAIIIItI!UEI'1'.l(SVN C014S71tUl:I1rJ0'fIIE WELL UAII•
q obolit Ill C (I I lgill it It) file Ph Willi it[Wider Q11:11111)"CI Illuldviater Secilon, 1636 A1011 Service Croce
I(IIVR07/211IN

I!(' .✓ 11 11 111 Il 1( li 11 lL,`
)111"U, CONS'1'ItUCTION IUXORD
14.iI Cat ld i:ta -Drpatlniclil of I'll v irouulcol and 14nlmal Rcsoputces-D\iviision�of Water(Quality- n Ulouadv nl Scnlio-a`t��
ttFl.l,CON-I RACI Olt I I N UI VIPIIAIJNAPIF Ip+lni)_y��YYS -S—S1.�-�` - —
\1 F mmr.
tcE1,1.CON I IIA C 10It Corld i'AN VN AllV,J1.VQ-C_W'Q.-\V_-11-'i �A(- ------------ luy) I57-;Z`3qY
ASSOCIA I ED tV01•F.li I11 —
$fA1F.RFIJ,('NNSIn1iCIlllN l'F.IUIFIM_—._____--_------- ifn � dicnLlc ,
i1❑ Air
• �licnlJr _
F. 'All
I. NiOSL (Chrck Applii Ilos): RrsiJrulial l hlunicipa1/1'ulrlic U Indosltial U Apicullmal U
NIcIliloling U Itccuvcty LI lied Pump %1, lrr liljccliolt U Other U If Other,List Usc-�--
2, \\'I U, LOCAL IOI'I: 1/ fulmErnlrbic/I,mxi sclliu);
Ncalcsl'fonn',�/1tdC_ --.____._Cvunly��!tQ.CD URidge LISlupc Iylkiilll Uflat
el'I" dn,t bill)
XL1ibS�.Ut�-._.�C�,__._._. _ ._ - .:-t'•.Ir LnliluJdlongiluJe of tvcR lucalinn
($lirrl Flmnq NnnJ�en,l'rnm,n„i:y$nlnli,i.ir„•L•d Iln.,7:p ) 13��2-`�y
+ ` (Arprcrdwinn:c✓e•ti,nnlQ
LaliUlJc/IonyiluJcsuwcc:LlliPSUfupvglaphicmap
(,^.nrrinrllnnirNn.) J)lCfJl UIUI-1,111(i-LQQ
Mfb��/lrC�� - --- Flow 'flr 1'vnnalioulJcsctipliun
t'rav
100
A,rn r,dr a. 1
5- IM"AI, DFPfIL-_ 3(Qs__ ___.--__-.
RFI'IACII I51SI Ill" WI'I.I'1 YIiS L.I IJU 111--
7. STATICWATRILLIVtil. 11c1ow'I'ul,of('ntingc__-SD_-.___I'I'.
(Ure"r"Ir Almcr lrp of l'nainPl
1) IS 1-F. Above I.mul Sul I'cc'
R. 'fI�IV OI't'ASIN __--�-___ --
•l rF rl[rdng In nJnnlyd nll•.r L[Inn In,ul cm Inrt,rq nitn• �
,nrin+ct In.ccmdrnrt nllh l SA NCAC IC III IN-
9. ti'IL•I.D (ppnl)' __LO- -Nilt 1110D OF]I:Sl'-lAi�
10. NVA I E'R 7,014FS(dcpllQ: ------- J IZCA IUfiSL4:CC)l LA
Nununl_1� Show diicctiu/l and distance in miles lion it I l
I I. DISII)fP.�IION:'f}Iie �-� — two Stale ILOalI9 Of C011lily ILOad9. III IIIJc Ihe' aJ
1Vail'Ihickncss
12. CASIWG: ouwbeis and common road names.
Ucpllt Dinuulcr of \VcighVfL Mali
1 Inm I o l'I._(o D 1 � ill
uP�er�•°.'b rEe 2d
Method
{. OROII h: I+rplh n r ntrn:,l
Il omb--'I'll
171oot--- Iv —11,--_--- t
Id. SCREW: hrpJl IJinulcicr Silo(sin.
p4alclinl zy sJ,
lyi Fit.—Ill. in. `3
15. SAND/URAWL PACE: v
hrPlll Si>•r hhdclinl -„
-----
I'tom _h1' I'1---- ------ -
C
Ill)Ill) I IFI'.I Itl' L•It OFl"1IIAl' MIS 1V1PI,1,WAS('OIJS1ltOC1F.D ill ACCURDANCR W1111 15A IJCAC 2C•\VI!LI.
CONS IUCI ION S I'ANUAIF AIJDlIIAT A COI'1'01''I111S RECORD HAS BEEN 11ROVIDID10'111U WILL OV,111 R
SIGNAII.11MOFPIlIt5UNCO1JSlRUCfINO'flit,'WI!I,I, IJA'll!
$uhwil the ut ll;In d It, the Dh idon of 11'tller r 11:1111p,iI aroldlealel-Secill+ 1636 D1nll Sel-vice ClilV-I 111?V. 11I121101

369886
IJollh l':u mina - 1 orm ImeOld I'rtr it nnu lent lilt" I I:,nual i!eaum ccs- Division of Wnir1 1 joalily - (11^nmP,valr, SccIi�40C'
..� tt'' ` �sw� ._ ,-Lltlll ll'nllntln _
RFIT CON IIt\I I till VIInI1l U11.N.)tJ,\nll: (p,6.11, -)GA�,,+5 h• W, - - - - -- -
t�F1.1.1"un rn\I"Ilnll nnirnnrr+nnn-. 1til',\��� W L .
n".UI'IA I Ir,It
SI.UC U11.1 rttt lS rnrr null l'LIrn111N. -.. . - - .. itn � dicnLlr _
iI a •lii.il•1"1 - ' . .
1. 1VPI i. I I$I' (l'Ir rl ,\pplirnhl;• IIn l RraiJrnlinl 41�7,Inuirilml/I'nbiic I-I Indn^hinl I I \I'Ii uI1n1:11 L I
LI^nil^t inl; l l Prr^crly I I Ilr:d I'nngl \l'alri 6grrlintt 1 I 1116cI 1 1 it ( Ihc1, 1is111Nc.1. \C I'I 11111 \ III 11 I: II \, 'I opolp:glhie/I.:Ind •:ell inl;
�11`�`t\' ^nitt C1l�CUI CN I II!i lyc 1 ISlapc Ijfv,�111ry 1 11 1:11
1),..���..r -I 1�,o.n (,hn L nl•pn:ly i,o-1..,.)
well
Im
r„....� .d�cr�e.r,�.h.��,l•.� 11•�, -q•t-•.L-I I.idlladt/Ioul;iluJc f
_.. ..-
1 Ir\':111:1 vcuce 1-1E-1i�'l''e. T,4\C1 r ,�T ii MCrnaI
- J I.alihnlr'I^u)!ilwlc Nuwcca 1(il'ol 1 I�q 1' '1' 1
AM" 6`t (i-rn Lf :bt.�r1 Un o4")
...... �') IIISI'.11l UI!ilJM10 L"';
I'^un•lli^n I'� Iiplion
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CA
,inn, ..1. I'n„•n•..nl,•i _5 IIII'111. IIP1'IIC -
6. Ia1fS \\•I'II, i!I'1'IAlPVSL;I HA; No" 17 - -"- --
----
7. SIAI11' \V,111',ItI IiPP.l. 11clo,v Iopa11
Ii 11' I 1'ASI111; I' F 1-. Al' , I.J111 •nll:u
•1..1•rl nd•�p hi nrl•„1 1 r , 1,.I,.n I,nJ.�n Ins♦,.pd�r„ -- - _.. -
,,,L,,<.b, .cr�•1a.,�,r„u61c\Ill"Al. tt•.ann
�. ) IF 1.1111'pn1J' O - tli(IIIIIIJ111 'IPA -- - - —
10 \VA I ER A IIIF ; D I IL) _. _ — 1,(j AI IV11_$51;1.CI l
f � Ann inl 15 - - iho(v dilection cold dislancc in miles 6onl al Ica;l
I I. I/ISJt ll'Itl llllll. I ,pc1\, VE�C0S5 1Am 11rii Lnrcn - — two Stale Roads (11 f (11111ly R0111S, 111(11111c the I^ad
11. Jf;: uunlhels and cumoum land mmmc''.
11�p111 I limnrlr, ,a lYri1;IJ'pl, t.Ldrl i:d
I11,1n.._L- -_1i ,301 II- (y��3S. _ SOi.�L .�✓C._- c .
t l�dn�d
Il. l;I!011I 11rl.gr nl'd•liJ ' �
It„111
11 St l!I'I'r 1. I'"p111 I iamrb•1 ';Io1 .';i:^ flaln inl ^
I'nn11---.__._ to . 11�_ _-__.
is. Snrli�rurn\ rl r,\l1: ,�
I r.L'I, Sirr 1
Io
rvy
Ila) ill'I'I'II, ( I I III 1 1II„T IIII , \ I'I.I. 11',1,rn1I;;fPll1.II:IlIllACCi RDAIV l',M11115Ai11;A(. 1( WEI.1 u
II'9J!;lAjlUA1!I,n,AHD IIIA1 A( (11'i Iit" II11,,ItliCUIIDIIAS111 1,111'RUVI111iU'll)'IIillVICI.I.I/JJ11111os
.\
l t .
- 'alilL\IIIPCnI' I'I'I!`intJCv11S1i!Ill'IUJ11111p \JI'1.1. I)nll.
';�Ivni! Ihi• at1^Iu i11• Ihr 11160...I III N ntr, Q11-11i(y",1;l umilliv„lel Becilull, 1616 Droll Selvlcel1;14'l 111!: 11N
11 )111'll

till it I
�ti vLL CONS] ItuCTION HE u�>�, 3 0 9 8 8 5
Idolth Caloli Ili - Pepalhncl:l of linvilul III will and I Inl�lgal�Itenooulm Division or Witter Ou•dily-Olooll'I ateI SccIioll �
S'Lrl/__.=L1Vi .Ge ---- 1�FII I ITICAIION n ---,--
V1F1.1,Cl/(rIIS.1lI jilt 11IJUIPIP11,1 1.)I`Inme gnl„o /" / - --- - - �. 81P11"..zSs1
1'llllN p. M
NN F 11,CON 1 Il.1Cllllt l "MrAr" "Pill' _ _--/!/�F� ---- -
ASSI/CIA I F.I)NO I-FAM11I N .__ .—_---- ------
5I-,1I E{1F1.1.( I,NS I ROTAIIIN 1'F:IN11 10. _._..—.____._--— ,
1l IT, dieahlc
its • lirnl dr ._ ,.... -.. . - .. . .. .. ... -
I.
\\'pl 1. I)Sh. ll Ir-cV, Applir;dllc Iloxl: I!c:idrnlial M'F t`luniripaVl'nblic l_l Indusq inl 17 Ahl icuhaud U
P.lnuitnl in}; L_7 1?Cener•I{' L1 Ilcal l'nnq, \1'alrl lnjcclion Ll t)thcl 1.1 If OIhcF, 1_Isll
2. WH L I (TCA I Il,H 1. Ji@e 'Iolln�rnithic/I;,nd �cllinp
L:Iliidge L1SIupe I-IV:,llry I-Illat
I1r:urnl I +V 11'///U�/"�__ (rlvckn(•(,.gni,trh,,•)
F7�i ee _ - Lnliludc7longilude of«/ellol ,c ll„n
d,ln iri,.n,l•Ilp..,np l'.dr) i r• dpp`dr6 f0'�.
(Ct,..l llnn mnm,h'. A I)JrC/I'�.Z�.:O L✓ /✓ _ _ -.
/ (drill c"h.d nm•ve nnI')
(if(I oI11!iludc 9oIIIcc:Gl,1 SI 1 f1gI1.pinphic rn:gt
(check lam,.)
1 ( ,i I In�•inr llvl IICI.111 U1:I L.1,111(t1Ol
AftOfPWS _NL-i8�o I_ Lounalion U uiptian
I,v �4,r„ar IIcln 'fo
A rn n•d 11
5 WFAI I'l'l'I IJU
G. OLrS \\ I•.1.1. RI LACE FNIS rnJt wrl l�! }'IIS L I
It -----
_ - ----
7. SIAIICWA11:11, 11;V1:1, 1101ow'fopof(•:Ieilq!:
i (1 Ur"r"IF AI rl •p.lY n inNl ----
13 l l)], Of CASIr11; IC .l Z 171. Ahme I.noll 111'1 e' -
•l••p rl nJ„p ,•,mLntrJ Ml",LrL,n
/ Z7
♦nllvnrr In�cc",du,cc nIt It i5,1 Nl'A(•IC III IP.
o YI1•I.1) t`tI?I IIUD I)I''I It 51_�x_______
__——
11). "'A 11.1t /11I1I S (dcptllp
L(LC AAIUIJ St 4TC71 �
i - Show dilcclion and dlgl lI1CC m nnlcs lioualilt
it. PI"Whii II011: 1 }pc_�7`T Alltonnl _ _—
lldrF:nrcP hvo;talc Roads or Connty Rond9. Include the 1
\V:,II d
12. CA51NI is nuillhcrs alld coolllloll load I1a111C9,
I)^plh Dimncicl o f���,Pl. lcf��Iial
lfl l,tll_ 1Z__ Lfl /.1J.._.1.1. G i2S _ _ /O _� •P/
will
it.
it. 11RMII- 1+rpt11 h Iru I
I10111
Floo
an
> , Ih Dlnotrlcr Slot tii�r I'lalrlinl to _
14. 5('LI l.ri. I p ,
Ill. -
Iloo1 -_ I1, _ __ fl._-,— l
IS_ SArJ1V!(iliA\'I'I. Plil'1;: -
I+rptll Si7o Llnlrl inl
will -
I1'(1111'P.hll'i llpllllAI "IIll" V"pl.l-WASC((rl.ill!I1(."IIIDItlACC�)ItIIANC[ WfLlllSAIiCAC2(',t;'Iil.l.
curls l lt.url n 11l ;r,vJl lAr.ns,non l nnl n cllp}• L)I rnls 1u��onD Ilns 111 L Ia rR.ovlue�� ���0 Jr (n;'I flat
---
-"-- --- - SIUIlAl11P.11UP1'IlR5Ur1C1) R NSIUCfIr1(I'llll?VJCI.I- UAII.
Snbntit the of Il;l11111!,Ihr tll{idnn of 1WMrl I itill )',lI of o lIvnler Seclloo, 1616 Milli ScnIt P(•(ill"T I!I�JI.Oi/)In!II

309883
WELL CONSTRUCTION RECORD
IJolth l':uolinn - Ilrl,atlnit,n of lil vilmuucut and tJa(wal RceoAm cca Ulvisiou of Walct (lu•Ilily- (hunnd';:nlcr `'caioll
-- yl� � L� "___ C Vill IF II_AI IIIIiN
R'FIJ,C11rVi It ACIUIt(IIJnI1'IPOAL)rJ,\nIF: 1,n hrll FC R- '-'—'
a� _
\\rll.fltr+n(:unnt( (rnu•Arv\'rlAnu' _ _ _ • _
SFAIF. \cF.IJ.C111,4$IltIu:llIIN I'EINIIIN___ - . .-____.
A 5511C IA'1 RII t\'IJ 1'EI2P117M ------
it nil rlicnblc
I. 1VP1 1, 1JSF. (Ch ck Applicable Bill) Rr^idrnlial I t Lmirillnl/Public U 111d"shinl 1A Ag6t,1111ua1 CI
RlonihninF, 1.1 It.crevrly I_I I lc:d Pump 1ValrF hljrclio❑ IJ Olivet I 1 If 0111cr, List
7, lVl'I L 111I'A 110111: L / 7'opuElallhidl,and rcttillm
IJcm rst'felvm l�/�'• __. _ /' -� I.Iltidµc [ I Illpc 1_IVallcy I.11 W
(chttk nppu,p,inle brn)
I,nliludrllonµiludcof%Nrlllacntie"
IStr-1 Ih , .N,"nl^, l'rinrm,niir Sul I rrii n,,I I I In.,lip 0,&)
Addle' j(j_ 51,,O1 On Spn25_ RCl _ _-- —_ I:diludlrlon{tiludcsowcc:O(dSlllnpo{,tapbicmap
( ❑.rl I„ 1!nni Ill .) IIL'hI11
1 28CtD b URILLIIIt 1 LUI,
A/L_ _.. .. .._.—._.- - loIllmliol, Uc .,iplion
07-af
1 11;\fItIYRIIII'1) 3 _ _ —
W1:1 1, 1i1:11 MT VNIS IIIJt; 1"'I'1.1 '! 'i I�.S [.I I,U l.✓ _--. _ _
7. SIAIIC %VAIFRI.BV1:1. Ilclow-f Ili,e1t
---
(U r"4"11 Al... 1•'I' 11 n•inNl ---`
I.nuJ .ln lace" ---�,
•-1.p�I r.Lr F,In minn Ril n1Ga hrin.. Innl vm lore,rgnlr n• ----,—�_____�
__--_--
,nrinr[r In von Jvn[>rvll 1, ISA rll'A f'N' III Ifl. �
V YIN 1 (t'I'n,) __-b _-_._ P+tI'.IIIUI)Uh I1•.51__....___..-___—_—
I[I. A'A11:R )I HUS (dr•ptlr):
T - Show dilcetion mid distance in "tile' lion nl Loa
If- UIS1141PV 11011: Tc,c_ T Atimilllt �`f t 1A—
I -�------- Sl
hvo nle Roads or Comel P.o y ads. Include the read
IZ. CASH!(;: Wall lbirknr'ra
V-1,tll IYi nnrlrl m WfiµhlNI. f.lnlclial uundlcls and common road Imulc'.
rlcllt------- Ito-- ------ ------ ` '.
I1mll is.
I t, GRUO 1: prptll pinlru,l hlalhod —
is
171enl 107�_-11.
,• rdl 1)Inlprlr[ 'tlnl tii;c Matcn:d
14. Sl RCIRd: I l
15, Si%IJI A;RAV1'1, PACI.:
I,•plh fire Llnlrt inl
I IlO I IFP,1D1' ( PR[II"i 1IIA 11lll'; VJI;l ],%VAS (' i 1:,IIlUC11(D 111 ACCORDANCR 1VITI1 I5A NCAC 2C•WIl,l.l,
CpplS I P.OI"I II IN S IAFlIIAI!DS,AND'I IIA I'A CuI"1" UI I IIIS IifCORU IIAS DLLN PItOVIDRD'l O"111R FVlll l O 11[`,p.
3 ev Af
- - ----- -
--- SIGt1AlU1!I UI I'I'II:;UN1:'OWSIICUCIRJ(I'IIIhVrP.LL I)AII.
Su1,111k Ills of I{:In'1l to the 1111 isiva of \1'atrl 11milily,1:1 nnnlArnlcr SPC111111, 1616 Milli Servlcc C I1'✓11 Isn"O010
001

11C c1 unru lr /fill `
wii,u, CONSTRUCIION RECOM 34
1JolllI Clip I,a -Dcl'alIllicit[ of 1?11vilmuncol cold tJ,lulal Resouic s-Division of Wntct Qonlity-Ul(lundwnler Sccli�u l
`CEI(I I F ICA"I I V N rr�,=1_O CI
WFLI,CON-I RACI OR(INIMII/nAL)NAM
__ASSOCIA"I E.O WI)",1161110
5 f A I F,\\-FILL CONS I It''C11ON "'"IIIM___._---- if n I dicoblc
it n ,licablr ..
1. \\'EI1, USE (Chrvk Applicnblc Dot): Residroli;d 1t1iPTunicipal/Public CI Indushinl 1J Agliadtulal Cl
Mouitol iog U Recov'ciy 1-1 I Icat Pump 1Vnlri Injccliull u Ulhcl U If OIIICr,List Usc-__--_.—_---
VIII,I, LUCA"IIUfI: I l TopogrnphidLaml Sclling
Z. \
Coo Illy LLe{ ❑Ridge LISlopc alley 1_I11at
IJcalcsl Iowl ' 1l� (d+rr►nl,rrnerime hnr)
h-E°� -- -- '- - ('1dr Lnli tilde/lungitudcUfwclllocatiuu
(SUrrl Inmq tJ..... r,Cnnunwlil)'.Sn1.Jicirinq Ltd Ila., ip )
•� Qlrp,erdu,inulydr�:an,l,)
L f �_1 ��`) -------- - LnlitudrJluogiludcsourec:Ll(iPSlJfupopinpbicmap
/�l (,rnrrl nr 11.nne Iln.)2 ryp ))L•L'Ul N LLING 1,00
4,11a-1 --��`"—"�'D� ----------- I'llllll "1�11 I�UIIIIn 11011 DCSI'I 1plllJll
0t) or
$Inle 7iir(luk �i ,
Nrn rl.Ic-
t- Jll Wl:1I ' vlsa fu) 11Y
7. S7 ATIC R'nl1i1C LEVIiI. Ilclu,v'1'op lr1('a^inl!' ._.__-. . ro
(O•r'•r••it Aln,rr'l np of('ndnp)
Above l.mld Sul lace' _
R. 111P UI't'ASINI7 IS —1 -- v -
•l rr rl rArLr y,,rnnlnnlyd nlfrr IrrLry IAnd"of."rrgnh rr• -__-_�---
,n,lAm,In Aannl u,re pill, I5A NCAC I III I9. "�
It I liuD UI' 'I PSI_ t..l_ - rs
10. W'A I ER ZONES
' 1 _ \S Show dilecliun and distance in miles frown nt IcnsW
I I. DISINIT.0 Alnuuut 11011:1)Iley�r�. n IWo State Ronds or Couuly Ituads. Include the Iond
\Vall'I I,ickurss
IZ. CASING: nundJcls and cmuwon road naulcs. _
Drrlll Dimnctet (it weight/H.ht/H. hlnlclial is
Ilom�__ 1u_aQ-- _ -
I°na❑ 1b II. - -.-
hom -
13. (i ROU I: Drrlll t nlcunl Method ip r
hum—Z) _ 111C_1*1.iQ1.'.— ` -- ��SEss 9 CDI'lUnl iU_ Il- _.--- .—_ ------ r
14. SCRI?EtJ; Drptil Uimucicr Flnl Sizc Matclinl �
H.
in.
--
15. SAN1,16RAVPLPACI';: pbdclinl
I Jeptil Sirc
flop) -I o ht'- — -----
DU I Ifl;1II\'CLI!TI11'1IIAl"I III;1^+I'LI,WASCU11S11tUCIi'.D Ill ACCURDANCE W1111 15A 1JCAC 2C,WELL
CONS I ItUCI IUN SIANDARDS,AND11IA7'A COPY lll''fIIIS 1tECUICD HAS BEE
I'ItUVIUEU'fU7111!WELL O(\'l iliR
._L�s25.—•�-
� 1
I------ ----- -
— SIG11A1UItltUl' I'I°.IttiIINCUtJS11lUCI1NO'1DI?WLII,L UA'IL
Submit lhr ollglnll Iv the Ph Won of Watrr l)ualily l;luuudrvnler Section, 1616 QlnllScn'he(-(,\Vrl REV. 01120111

i!li it
lu, mlrn n
- - - " AVIAJ, CONSFRUC ION RCCotzu
IJollh Cnl Mina -Urpal talent of Euvimunlenl and tJnl al Itesou CS'DiviSloll of Witter Quality-(31 ound water Seeliull 3
jay �w `CrallriCAUUM
}Vr.1.L CON-I RACIOR(IN111V•IDUAI•)N,\niE (p,hu1—�.—'y Zyc,
'/ ru +r.in n L� Y /
IvrI.I.CONIItnCLOncohtrnr+vNpuc A __ �/�1 _
nssoclnlRu w(}rennn"1M
SrAI r,VVE1,I,CONFIItUCII(IN r'F.IINfrN_______—._- ifn : rlicnblc
I. 11'L•LL I_ISh(Check Applicnblc Ilux): Rcsith 16:11 L hmic{psllPublic❑ Induntlinl ❑ Agliculnunl U
hlon-1,I-IS ❑ ILck velyAppl 17 Ilcal Pump 1v alcr lajcclioll U Olhct ❑ If Olhct,List User---
2. 1VP.IA, I OCA 11014: / — / TopOgtnphi(/Lnnd scllial;
IJcalc.•.l'Iu1ru1G/✓/ /'1 ---Cmm,f�—`{1,"Iee CJltidge l_ISlopc UVnlley IJI`lal
(Chec)(appunninle hnr)
lilt N . zip Cl.lr) Latiluddlungilude of well lucnlinn n
(Sllrcl Nmnq Nuudn.,l onununi:p,• p/ W a
til '�S'
C (degtetJndnnledrrcnnd.)
3. 0xVNl:tt:-4&V >' L�f�'�rhe� mJ�
I-Milmlellungrw U
de soutceIMPSTupoglap -1 hie 111
AJJress
(check Mre)
(Sbrrl nr
spy 12LLIJl
—1ti1srY�1e.. �V�---°-� -- --._----- Flom To funnalionDcsclipliuu
zil,("Ar
--
A,ra u-Ir-
4. I'Al I? DRII I f1)
6- UCIPS P'1'.LL III;P -ACII 11XISJ'IMI WE1.1,1 Yll U JU �
7. S I'M IC WA"I lilt LEVEL Uclow'fop of('n^.iuh:_y-._.__I
� (Lhe•.1"It Alnnr lap of/'n<inpl � ,,,�
S. T(V(it:CASING IS-_ '✓_---11. Ab(rvr Lund Sullecc'
•'trp nl ndne IR nJn nlyd•1/.n-Lrinn lalul nnlnrt rt�pd,n a adi
nall•uce In acrm dune wI111 15A NCAC 2C.o1In
NGD 0171 I r A r —
IU. WM ER ZUNES(dcp(h): 1(Z4A11U1 -
/ yr---'Alllmnll -q�f _ Show ditccliun slid dislnnce in miles li onl nl Icnz
It. DISINPGC 11014: • ylle� �7�__._—`Am ilickncss two Slnlc Itonds or Comely Itoads. Include the road
12. CASING: numbers told collation load jinnim
uhcl,l Dinutcicr or 1VcighUPl. tclial jxe4end,
i'rrmh ntr "13. GILOLI I- Drptll 14. SCREW: Drptll Uian¢trr ,Inl 7irc h1a(crnflout15, SANI)IURAVPL VACK:I lrl,lh SiteFwIII IO
IDOIIfRPUl CI'C ll f}"IIIA'1"IIIIS1VIiL1,1VA[ COI IS'I'Rl1CL111)INACCORUANCEWITII15ANCAC2C,WITI.
CONS I RUCI WIN S T D T
ANDARDS,ANII/IAAI-ACUI'YUf•i11ISIlElCURDIIASUEENPItOVIDCDTOTIIL'WL'LLOWl![;R .
—��— � - —
SIUNAIUlt ,OFVIItSUNCUIJSIRUCI1tJ0'IIIRWI?I,L UAIL
Submit IItr m I;;lu tl Ic Ihr Nil idon of Wnlrr (3un111}'r(:rnundtvnlcr Secliou, 1636 plsll Service Cenicir IN!V'' 1,r4f: I

11�
11'P;Ll , t_t)I ,liTItUI '1ION RECORD (,� � 8r9
I1,911i ( ':n11111':I - I4ltirtlnlcld.,Il'llvilm III IrilI III I,III:,Itllalllr9Urt1cel- I)Ivl':irrl I 'll W:11fI (III nliIy- nt,'I
\a V r
\\FII./ UGiI'.\l-IIIiI IIIlbI\lPll fJ,\\1) nll- Iiv lull �, 1 SC:n _ _ .. I'VIllll_Allr,tth ,�NoLl-
. �ti' ��@� W�U JC''�1�AO rnunlc n 1'sarsl`ci/-1ti97
))r11.I�nt�ittnrnnulmn'nrJ\ u,\nn' - - -
SIAI F, IJ.rn;;Sl❑I,l"I I(,N 1'{ It niI I If ._
_... . A$W)1 I A I P.1) IV 1) I'l It Pl I I
it r .l is all•'1 __ . if r di,-tLl�' ..
I. t`:PI I. i l',P yl'Ir'rb. ,119 Ii. .ALL•• I1.1)p. Rr^idrulinl h�Llunirilral/I'nldiq I .I ludush ial I I Alpi. ullmal I.1 T
LL•nihainy, ll I'rrm rt 11 Ilrnl l'nnq, 1';:rll hrjrrii.nlll (Ilhl•lll 11 (IILcI, I,ia 11^•c- , _..- .. --,3 _
\C I'll I ! n A I II tl 1. I„lu,l,lnlrhi '.I and Ilulp 0p
I ..,,,.•I .1,•r•.n' 1ur4}�1�` t .mnr; Cy�(j-�(���� III'idµc II';Inpr ICI � III1.,1 ru
nl!m.... l )
' �O
I.rlilndr/IunµiLnlr of ,II L,. aj.;,t
a�
L. r •t J.n , I n, ..., ...........,.'.J-li.r.. . I..r I1.. III I ,.,I-) ..
l:rl' l
l cuce � e U�-lei �C)
t kt
.Lo ll 64 Wac e A45K I ',1ilu.l.'rl, nµipulc ^.uun,c'1 t!il' I I I,•p.q'r q hi.' nr,lr
)'....r..r i'.-1. rIr.!
A/c ZS906 1Ntl'lll 111!II.1.11)IiL! rri
tiluf�Ar h - ul,l r.m
I�,n ulelinnl
!. I�I11"� W1:11, I!I'I'1 '\t'1'. I"i I';I [lit; VIA] 11, ��--
7. IA111 VVIA llrinvlr•pr.(I'. .r ,! .
I'. It ,I• t 'I' t A':II II : I: i I- I . Alm,T 1a10 !;m[:if
•I•y. rl r•J..p b.rn L.+bJ ..P n 1.•L•.•(nul .n,ln.r,nl.q,.. • ry
.,,!.,...b .\nrArn'.nitn. _-- -
p } Il l lrllllnl. - .(,� LtllI lit lI1 11711:.;l
Lvf(:A1i1111
II. 1'I`;II!IIt'IIf111.'1 .pc�tih l\\��s. - Am....ill 1.0
SIImv ditc,iilm and dwhncc in nlihs limn �t I nil
V ,IIlLi 4n•-a I\V) !;I:IICl ombtirl�.unnly l!r,a,l•L Inclnll 16r I ,'Id
12. t .A'•Itl1 unm6rls and cunullu❑ luny unw^�.
I`-poll Ilnn„L�1 , r \ �i -0d'11. I.Inirli:d
r.101....1
Ft ,�UA rl�
I1. `,l I!I L11: I''pnl I,iem t t !:Irl ::i , Vbl,linl
W
il,.
Ilrn1.- to Il.
II`tr1111'.IllitINIIt 'I 11M II11; V.1:11 VW;II!IC;l lilt('11'll Ill AI'( IIIII)AIII(T %VI111I , IWAr)r, VW1,
rt)t!s l hi It I U 11I I Al11IArl C:,Atli I I IA I A I I II'i (11''I III S I!lil'1)I!Iy HAS 1311111•I!I)VIUI'. )'ll)lIII!V"I:IJ,u7:1ll l'
- -
- -- ---_ - ail v .S .
---�w-�--
.':R:I1,\I1 fill! I,I- I'I'f•.Sl 111l'1)tl.r,11!IN. Ilttii 111F1r'P.L1. I i A l l J.
Cn!•n.i! rl,: nli on .t1., "mI'I.i-irn ul \•i:,Ir, Ir'tz,Lfs, 1:I npndlt'PIl'f�;I'CIItHI, I41h MMISCI Il(r Cr ,I,[- Pcl,11'1" r:l

irr_�_�►RIP
I I� IIh I nI•li�l:r - 14I•:n ho' I;1 •I Fuvinnnnrnl III I, I lotlot.d Itcnul 11 c,•a - Ui�i^ion n(W:11''1 Dune ily - Ito nod:•:•t b•I `;,'• li ant ��
��ecc nInlllnunnit � 7
tt r t l I.n^:n! \1 Inn Innuslniul I I+,\nn.
ttlllrn:n It ur. rnnm III N,\nW. . .l%/' -r11nIIr n (b',cYtb'�)-,Zyf)
�;5111'IA I I"1) 1111 1-1.11"11 M
nin'i II IN 1'I if PII Ifl - iln � di:alil�'
I. '.�PI I. I itil II 'h• rl •\pldil-alllc Iin•I RraiL uli:Il Itt1lmi, ImIll'nhli, I.I halo^Ilia) I I /\pli• 1111,1rd I I
("h•uil,n in;•. I .I I'rr, rr; II IL•at I'unq, 'J:alrl hlj,'I IiIm I.I Illhclll Ifl nh,l, List 1 l v.
\:'I I I I III "AIII !I 1 '1111n Ilq aldlicil :IIV] •:',Ilinp,
I , �f'(/"rwrf Woolf C�ZfO(LC� I ll'i0v I I';lop,- l k,olh.y 1111-0
.r�l ll�•.n'
�� , ht`icit !.%ikgc � t,a..I �1.1,,,.1•,,.LI,...j
G�•' I nlilmlc/Ioup,ilnJt• u(:'�r'll In. :+ern
1 N 35' 1 3'ocF �l W 83°49
q / � pl.yr.r•4nlmp-. ,..,.nd'1
7t, lUl";III
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I,nIiInJ�/Lnynindc sunmc:l Iq' I
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WELL CONSTRUCTION RECORD North Carolina Department of Enviromnent and Natural Resources-Division of Water Quality 3 0 8 794
WELL CONTRA(9'0R(INDIVI n1AL)NAME (prinQ CALVIN W. ROSE CFRTIFICATION M 332T
W'F.LL CONTRAC-FORCOMPANY NAME ROSE'S WELL DRILLING PIIONE H (z1d*)442-3431
STATE WELL CONSTRUCTION PERMFFN _ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
L WELL USE(Check Applicable Box):Residential X Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topog phic/Land setting
Nearest Town: MURPHY CounIV CHEROKEE _ ❑Ridge Tlope ❑Valley ❑Flat
5224 HWY 294 Latitude(check appropriate box)
(Street Name,Numbers,Community.Subdivision.Lot No.,Zip Cede) longitude of well location
3. OWNER:_NATHAN HARBIN (degrees/minutes/seconds)
Address 55 YONCE RD — ___ Lalitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
MURPHY NC 26906 DEPT14 DRILLING LOG
Citv or orn State Zip Code From TO
T Formation Description
(' 1fi-226-4199 0'T_O 50' _ -- RED CLAYISANDSTONE
,Area axle-Phone nranber 50'TO 66' - GRANITE
—_—__
4. DATE DRILLED 03/0912005 66'TO 300' GRANITE
5. TOTAL DEPTH: 300'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1 .
7. STATIC WATER LEVEL Below Top of Casing: 10 __Fr.
(Use"+"if Above Top al-Casing)
--- -- —
8. TOP OF CASING IS I FT. Above Land Surface* ----_------
•Top of casing terminated atior below land surface requires a '-_—"—-----
variance in accorrlanee with"A NCAC 2C.0118. ---------
9. YIELD(gpm): 9 METHOD OF TEST AIR
10. WATER ZONES (depth): 85'-3 GPM, 190'-2 GPM,292'-4 GPM — -- LOCATION SKETCH
11. DISINFECTION:Type CLORINE Amount 100 PPM— Show direction and distance in miles from at leas!
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/PL Millmal numbers and corninot mad names.
From 0 _To 66 Ft. 61/8" SDR 21 PVC_ (ill Cn
From To Ft. _ 2
13. GROUT: Depth Material Mdhod / �� ) _ _3
From 0 To 20 Ft.CEMENT GRAVITY , o�
- -i o
From To FL__ __ D rrrm
14. SCREEN: Depth Diameter Slot Size Maletial 1� R ^b . 3 —nip
Front To Fr._ in. in. _ j1 ( o�
0
From _ To Ft. in. --- in. _ t\J C A CV
From (J N:z=
15, SAND/GRAVEL PACK: \ m
Depth Size Mutcti:d
From----90 FL
From T'o FL ------'
16. REMARKS:
I DO I IERFBY CER'11FY TIIAI IIIIS WELL WAS CONS RUC IIM 1N ACCORDANCE WITH 15A NCAC 2C,WELL _
CONSTRUCTION STANDARI)S,AND I C PY OF TJ IIS RI-'CORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGN OF PERSON C( NUCFI�NG���
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 9
North Carolina Department of Emironent and Natural Resources-Div of Water Quality J 8
m 79 g
WELL CYINTRACCOR(INDIVIDUAL)NAME (FORD WILLIAM BRADLEY LEWIS CERTIFICATION a 3368 d
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PIIONE 4 [phone]
STATE.WELL CONSTRUCTION PE.RMIT0 ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Q I Mmricipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Waler{nlection❑ Other❑ If Other. List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY _ County CHEROKEE I�Ridgc ❑Slope ❑Valley ❑Flat
_M_Y_ERS BRANCH TO TRAILS END RD / (check appropriate box)
11"trettt Name,Numbers,Cnmmnnity.Subdivision,IAt No.,Zip('ode) Lalitude/longitude of well location
1. OWNER: KATHYSNEED -_ -.-_____ --- (degrecc'minulea/seconds)
__ — —
Address 530 MYERS BRANCH RD —_ _ Latitude/longitude source:❑heck❑Topoglap rc map
(SireA nr Rome No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
'tv m'I own stag Zip Code— --_ "_-- From To Formation Description
(828_)- 837-2270 0'TO 20' BROWN DIRT
----------- - --.-__
lees tale-Phone munher 20'TO GO _ _ BROWN(fAN SLATE
4. DATE DRILLED 0 310 9/2 0 0 5 GO'TO 90' BLUE SLATE
— ------ -- - —
5. TOTAL DEPTH: 405' _ __ 9010405 SLATE
6. DOES WELL REPLACE EXISTING WELD YFS ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 75—__ F1..
(l lse"+"if AFave Top of Cnsint±)
K. 1OP OF CASING IS t FT. Abovc Land SioT'ce**Top of of mslnp fermirrattd atp,r heluw land surface mgntrw a - — -- — ----
varianra In accurdamesrith l 5A NCAC2C.0118. --- --_-----
9. YIELD(gpm): 4 METHOD OF TEST NR-- ----- —N `n
10. WATER ZONES(dcplh): —__-- -- ---- — p <
LOCATION SKETCH
Show direction and distance in miles fro1R%l least-urn
11. DISINFECTION: Type CHLORINE Amount 100 P_PM_ ID
11 CASING:
Wall Ituckm s lico Stale Roads or Counly Roads. lncludgie T04,
Depth Diameter nr Wcigh1/Pt M.derial numbers and comnx,n mad ItarneS. �tZ
From 0 To 90 FI. 6118" SDR 21 .PVC C� _ —4'n
From To Ft.
C N
Fmm -- To — F1.
13- GROUT: Depth Material -- Method i(t} X c1r)
Fmm 0 To 20 Ft.CEMENT _ GRAVITY__ k
From TO Ft__.__ _
I•t. SCREEN: Ikplh Diameter Slot Size Material P_ l
From To
IS SAND/GRAVEL PACK'
ik'Pth Size Macri:J
Fmm To Ft. `i
Firor
I6. REMARKS -----
I DO UFRIiBY CERTIFY THAT"IBIS WELL WAS CONSCRUCTI?D IN ACCORDANCE WITH 15A NCAC 2C,WELT.
CONSIRLICTTON STANDARDS,AND THAT A COPY OF THIS RECORD HAS DEEN 'ROV9DED TO THE WELL OWNER
-- SIGNATUREOE PERSON CONRTRUC'H Ill i WELL DAIF
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 34)trays.
GW-I REV.09/2004

308802
WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDINIDUAL)NAME (priaq CALVIN W.ROSE CERTIFICATION#3327
WELL CONTRACTOR COMPANY NAME ROSE'S WELL DRILLING _PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ IIT#
(if applicable) _ (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Waterinjection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo hic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
TARHEEL WEST TO WINTERGREEN LN cb k appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Codr) Latitudeflongitude of well location
3. OWNER: TOMMY HAYES-K.H.K.CONSTRUCTION (degrees/minutes/second°)
Address 2127 CULBERSON RD Latitude/longitude source:❑GPS❑Topognapluc map
(check box)
(Street or Rome No.)
MURPHY NC 28904 _ DEPTH DRILLING LOG
From To Formation Description
City or"Tm stale ZAP Code RED CLAY/SANDSTONE
(ALB_)-644-5641 0'TO 50' ----_
Area code-Phone number 50'TO 400'_ GRANITE P
4. DATE DRILLED 03/02/2005 fi
5. TOTAL DEPTH: 400' __ -A
6. DOES WELL REPLACE EXISTING WELL? YF.S ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 60
(Llsc"+"if Above Top of Casing) (,}
8. TOP OF CASING IS 2 FT. Above Land Surface*
-fop of casing term(nated aver below land surface requires a
O
variance In accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 20 METHOD OF TEST AIR
t,3 r�np
10. WATER ZONES(depth): 260'-8 GPM
385'-t2 GPM LOCATION SKETCH
Show direction and distance in miles from at least
11. DISINFECTION:Type CHLORINE Amount 100 PPM two State Roads or County Roads. Include the road
12. CASING: Wnll'Ihickncss
I)cpth Diameter or W6911t/Ft Malefial numbers and common road names.
From 0 To 60 Ft.. 61/8- SDR 21 PVC
From To Ft.
romFt._
F To FL
13. GROUT: Depth Material Mediod i
From 0 To 20 Ft.CEMENT GRAVITY
From To FL
14. SCREEN: Depth Diameter Slot Size Material -
From To Ft. in. it,
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth S ZC Material
From To Ft. —.
From To Ft.
16, REMARKS:
I DO HEREBY CERTIFY THAT TIIIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL ._
CONSTRUCTION STANDARDS,AND IHAT A COPY OF'Iju S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONS RUCTTNO I IIE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh.NC 27699-1617, Phone No.[phone],within 30 day& GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 3 0 8 8 01
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDryIDUAL)NAME (pri.t)
CALVIN W.ROSE CERTIFICATION 0 3321
PHONE q [phone]
W'F.I.L CONTRACTOR COMPANY NAME ROSE'S WELL DRILLING
STATE WELL CONSTRUCTION PEAMTT ASSOCIATED WQ PERMITM
M (if applicable)
(if applicable)
I. WELL USE(Check Applicable Box):Residential)4 Murdcipal/Public O Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water'injection❑ Other❑ if other,List Use
2. WELL LOCATION: ,111 Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE YlRidge []Slope ❑Valley OFlat
` (cluck appropriate box)
EBENEZER RD Latitude/longitude of well location
(Street Name.Numbers,Comlmmity,Subdivision,Lot No.,Zip Code)
(degrees/mialf eslseemda)
3. OWNER: KENNETH KEPHART —._— pomp 'hie p
Address 10 DOGWOOD DR Laliutdc/longitude source:❑GPS❑To ttra
(check box)
(Slmet or EOutc No.) DEPTH DRILLING LOU
MURPHY NC 28904 ___--
City or Town Slate Zip Code Front 'FO Formation Description
0'TO 45' BROWN DIRTISANDSTONE7
(828 )-837.4783 — — GRANITE O Gr'A
.Area code-Phone number 45'TO 500' Ur ��
4. DATE DRILLED 0310412005
5. TOTAL DEPTH: 500' ar
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 80
(Use"+"if Above Top Of Casing) I
S. TOP OF CASING IS 1 FT. Above Lard Surface*
-Top of casing tesmWted at/nr below Iard surface requim a Z
var lance in acrordarrce with ISA NCAC 2C.OIIIL n�
9. YIELD(gpm): 3 METHOD OF TEST AIR — co
10. WATER ZONES(depth): 195'-3 GPM LOCATION SKETCH
Slow direction and distance in miles from at least
11. DISINFECTION:Type CHLORINE Amount 100 PPM two State Roads or County Roads.Include the road
12. CASING: Wall Thickness numbers and common road names.
Depth Diameter or Weight/11 Material
From 0 To 51 Ft. 6 118' SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method 9[
From 0 To 20 FL CEMENT _GRAVITY
From To FL -- T
14. SCREEN: Depth Diameter Slot Size Material Z �
From To Ft. in. in. a m
From To Ft. in. in. _ N Qj
15. SAND/GRAVEL PACK:
Depth Size Material 1yu
From To Ft.
From To Ft.
16, REMARKS:
I Do HEREBY CERHFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Willi 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND T A COPY OF THIS RECORD HAS BEEN PROVIDED TO TIIE WELL OWNER
100)
SIGNA-rURF OF PERSONCONSIRUCIINU It1EW111 DATE
Submit the original to the Division of Water Quality,Attn: information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. GW-I REV.0912004

WELL CONSTRUCTION RECORD
North Carolina Department of Envirommal and Natural Resources-Division of Water Quality e p n 0
WELL CONTRACTOR(INDIVIDUAL)NAME (prlat) CALVIN W. ROSE CERTIFICATION#3327 Q it
WELL CONTRACTOR COMPANY NAME ROSE'S WELL DRILLING PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Wate nlection❑ Other❑ If Other.List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE Ridge ❑Slope ❑Valley ❑Flat
NORTH OAK ESTATES (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Clwle) Latitudellongitude of well location
3. OWNER. JAMES MONEYMAKER _ (degrees/minutes/aecotds)
Address 1285 WEST U.S.HWY 64 Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
MURPHY NC 28904 _ DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
(828 )-837-4488 U TO 40' RED CLAY
Area code-Phone number 40'TO 55' GRANITE
4. DATE DRILLED 03/01/2005 55'TO 700' GRANITE
5. TOTAL DEPTH: 700'
6. DOES WELL REPLACE EXISTING WELL'? YES❑ NOA _
7. STATIC WATER LEVEL Below Top of Casing: 60 FT.
(Use"+^if Above Tnp of Cnsing)
S. TOP OF CASING IS I FT. Above Land Surface* __ c
*Top of"slna terminated atlor below land surface require a
En
variance in accordance with 15A NCAC 2C.0119. -- m
9. YIELD(gpm): 1 1/2 METHOD OF TEST AIR
10. WATER ZONES(depth): 105'-112 GPM __-- LOCATION SKETCH `'1
230'-1 GPM
It. DISINFECTION:Type CHLORINE Amount too PPM Show direction and distance in miles from all t rnrl,
12. CASING: two Stale Roads or County Roads.Include the�ad
Wall'Ilticknesc o
Depth Diameter or WeighUFt. Material
numbers and common mad names.
Fmm 0 TO 55 F(. 6 1/8' SDR 21 _PVC PC)
cri
From To Ft.
Fmm To Ft.
13. GROUT: Depth Material Method 0
From 0 To 20 Ft.CEMENT GRAVITY__ l �i
From To Ft.
14. SCREEN: I)eptr Diameter Slot Size Mnhfiial S
From To Ft, in. in. ---
From—To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I IX)HEREBY CERTIFY THAT THIS WELL WAS CONS]RUC'1171)IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND 11 C PY OF THIS RECORD S BEEN PROVIDED TO THE WELL OWNER
wit` 'I ` �!1( .3 -7�-oS
SIGNAJURE OF PERSON CONSTRUCTING 11IF WELL DA IE
Submit the original to the Division of Water Quality,Attn:Information M anagement,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 311 days.
GW-1 REV.09/21]04

WELL CONSTRUCTION RECORD 308799
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (pd t) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL.CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. pHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERa11T#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):ResidentiaIX Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Mt40H Y County CHEROKEE )❑Ridge ❑Slope ❑Valley ❑Flat
MOCASSIN CREEK TO NORTH FORTY _ (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: WINDELL ANDERSON (degrees/minmex/seconds)
Address 1425 BURNT SCHOOLHOUSE RD Latitude/longitude Source:❑GPS❑Topographic map
(Street or Route No.) (check box)
fte6,V511E' INC 28904 DEPTH DRILLING LOG
cityor Town State ZIP Code From To Formation Description
(828 )-389-8986 0'TO 20' _ REDIBROWN DIRT
Area code-Phoneamber 20'TO160' TAN SANDSTONE
4. DATE DRILLED 03/01/2005 160'TO 200' SOFT SLATE
5. TOTAL DEPTH: 385' 200'TO 210' DARK BLUE SLATE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9( 210'TO 385' SLATE
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if Above Top of Casing) ----
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of"sing termhuted 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):
LOCATION SKETCH O n
Amount 100 PPM Show direction and distance in miles from
11. DISINFECTION:Type CHLORINE
12. CASING: Wall Thickness two Slate Roads or County Roads. lncludead or"
Depth Diameter or Weight/R. Material numbets and common road names. OC'
Fmm 0 To 210 Ft. 6114' .198 GALV STL
t*+
From To Ft.
From To Ft.
13. GROUT: Depth Material Method cnP
From 0 To 20 FL CEMENT GRAVITY L� � n
From To FL �`. LA2 >^) ,
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From Tri Ft. in. in.
15. SAND/GRAVEI- PACK: —— �' ✓f
Depth Size Material '
From To FL _ r
Fmm To Ft. 14 w 4J
16. REMARKS:
I DO HEREBY CERTIFY THAT TI IIS WELL WAS CONS7RUC1ED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS ORb AS IIEEPPR VIDEll TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTTN IE WELi, DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 3 0 9 0 5 5
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WF,LL(bNTRACIORQNDIVIDUAL)NAME (padot) WILLIAM BRADLEY LEWIS CERTIFICATION#3n
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE to (828)837A008_
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMIT#
(if appficable) (if aliplicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural
Monitoring❑ Recovery ❑ Heat Pump Water n)ection❑ Other❑ If Other. List Use
N fC-
2. WELL LOCATION: "I'opographic/Land settm ` w -
Nearest Town: MURPHY _County CHEROKEE �Ridgc ❑Slope ❑Valley gFJat ry
MARY KING MTN.(OFF MARTINS CREEK RD) (check appropriate box) 0 0 1 C
(Street Name.Numbers,Cautionary,Subdivision,Lot No..Zip Cade) (.atuiulde/longitude of well IO e5 r,
a. OWNER: GLENN ROBERTS (degrees/minutes/seconds)
Address 6165 WEST U.S.HWY 64 Latiwde/longitude source:❑GIPS❑Topographic map
- — (cheek box)
(Strew or Rmnc No.) DRILLING LOG
MURPHY NC 28906 DLP-I-)a
City or Iown State Zip Code —. ---- Fmn) TO Formation Description
(828 )-837-8557
0'TO,60'- BROWNITAN SLATE
_ - -----
Area code-Phone manber 60'TO 80' _ BLUE SLATE
4. DATE DRILLED 03108/2005 80'TO_.1000'-_-___ SLATE
5, TOTAL DEPTH: 1000'
6. DOES WELL REPLACE EXISTING WELL? YE.S❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 705----
1-1.
(tile"+' if Above lop o(('acing)
8. TOP OF CASING IS_]—_FT. Above Land Surface' _-- - -.
**top of rosin=termhwted atior helu r land surface requires a -- --___
vari.weIn acmrdan w8h 15A NCAC247-01111.
9. YIELD(gpm): 117 METHOD OF TEST_AIR, _ -
10. W ATF.R ZONES LOCATION SKETCH
----------
Shot; direction and distance in miles fromat least
I I. DISINFECTION:Tvpe CHLORINE Artaum_1OO,PPM INN Slate Roads or County Roads. Include the road
--
12. CASING: Wall l hir'ktiese
Depth Diameter or WeightlPt Material numbers antl common road names.
From 0 To 80 Ft. 6118- SDR 21 PVC__
From To FL ---_ --From To FI. —_-- �•.: (I �fl
13. GROUT: ikplh Material Method 11>
From_0 To 20 Ft.CEMENT GRAVITY '- a.
From To Ft. --- (11VA
14. SCREEN: Dp0) Diameter Slot Size M dc'ti.dIV t Caw
From To F1. in. in __- _-- �
From To Ft. in. in. cn o-
tr
`/
15. SAND/GRAVEL PACK:
Depth Size M:ncri,d _.
Front To Ft.
From To Ft. 2L L"e�51­
I6. REMARKS: —
I IX)HEREBY CERTIFY IIIA'f'fI[IS WELL WAS CON STRUCII:D IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF"fI11S RECO H S BF.FN PROVIDED TO TILE WELL OWNER
l 3 _l-(
fil 2 `
SIGNATURE OF PERSON COlNSTRUCTING 117, 1_1,1. DAIS
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days, GW-I REV.0912004

WELL CONSTRUCTION RECORD 3 0 9 0 5 4
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (pYt) WILLIAM BRADLEY LEWIS CERTIFICATIONa3
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PIIONE R [phone]
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential 14 MunicipallPublic ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If OUter.List Use
2. WELL LOCATION: TOPOgriphic/Land setting
Nearest Town: MURPHY County CHEROKEE_ - ❑R.idge lope ❑VBoey ❑Flat
OGREETA TO LUTHER KIDO RD (chc k appropriate box)
(Street Name,Numbers,Community.Sobdiviaion,L.ot No-Zip Cede) L.nitude/longitude of well location
3. OWNER: JOE BARNETT Qlee see/minmex/seconds)
- -- I>oBmP P
Address 890 RESERVOIR RD Lauhidc/lo»gmtde source:❑heck TO a rtta
__—.-- .__—_ (check box)
(Street or Route No.) DRILLING LOG
MURPHY NC 28906 DEF''I'H
-- ----...___.-_- Pm»r 'ib FormalionDescription
iry C or'lov n State Zip Code RED CLAY
(828 )-837A681 0'TO 20' -_
Area code-Phone number 20 TO 40 ____,—__ SANDSTONE . -
4. DATE DRILLED 03/14/2005 40'TO 60 _BLUE GRANITE _.
S. TOTAL DEPTH: 805' 60 TO 805_ _._ -_ GRANITE 5.1.E
6. DOES WELL REPLACE EXISTING WELL? YFS❑ NO ^
7. STATIC WATER LEVEL Below Top of Casing 260_
(Use"+"il AFrove'1'op
8. TOP OF CASING IS 1 Ff. Above Land Surface*
- ---- ---- *_- t>o
"Top of cas6r8 termhnted N/nr below End surface requ{m a
♦arianre In accordance with/SA N(:'AC IC.O11R.
i17 METHOD OF TEST AIR-__
9. YIELD(gpm): -
10. W ATER ZONES (depth): LOCATION SKETCH z• E G
Show direction and distance in miles frotjflit ld f-' --'
1 I. DISINFECTION:Type_C_HLORINE AlilOnllt_100 PPM Iwo Stale Roads or County Roads. Include the road'
12. CASING: Wall Thickoesc -- ----
Depth Diameter or Weight/Ft. at al
Immbers and common mad names. ._.
From 0 To 60 Ft. 6118- SDR 21 PVC
From To Ft.
Front To Ft. _
13. GROUT: Depth Material Method 'rt 3 mm
From_0 To 20 Ft.CEMENT GRAVITY
From To FL_ __--._— ? L,4
14. SCREEN: Depth Diameter Slot Sizc h1ntctial
From To FI, in. it' ------ o ,
From To Ft. in. i» ___ u7
15. SAND/GRAVEL PACK:
Depth Size [�
From TO FL _.-.. ----
From To Ft.
16. REMARKS: ---
I DO 1117.RE13Y CERIIFYTHAT TTOS WELL W S CONSI'RUC'I F.D IN ACCORDANCE WITH 15A NCAC 2C,WELI.
CONSTRUCTION STANDARDS, OP'DIiS RF RD41RIiI:N PI VIDED TO THE WELL OWNER
OF PERSON CON.S`TRUCTI T E WI?LI, DA'I E
Submit the original to the Division of Water Quality,Attn: Information Management, 1617 Man Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 309195
North Carolina-Department of Environment and Natural�R,eso/u�rceg`-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM�,Ep�(pr'int) `axks y, p (L.1(-�'�
WELL CONTRACTOR COMPANy NAME `r''n T y 1l_l t (wI�' CERTIFICATION##,9139
STATE WELL CONSTRUCTION PERMTI';Y PHONE
(if applicable) AeCOCIATED WQ PERMIT#
(if applicable)
1. WELL USE(Check Applicable Box):Residential MunicipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOC
OCMe-sres
rt Townown> V� �ounTy, TDPollic/Land setting
❑Ridge Slope ❑Valley ❑Flat
(Street Name, umbers, muuit34 ub ' riots Lot No.,Zip Code) (check appropriate box)
3. OWNER: Latitude/longitude of well location
Address (degteearminutes/seconds)
. Anne or Route No.) �j" i Latitude/longitudesource:❑GPS❑Topographicmap
C J r� (Check box)
tty or Town State Zip Code 1 p-`
Phone ber p From i 5 t F rma 'on ese 'ption
Am code O
4. DATE DRILLED
5. TOTAL DEPTH: g
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO I>f/
7. STATIC WATER LEVEL Below Top of Casing: (DU
FT.
8. TOP OF CASING IS (Use . boveAbove Top Surfaces
FT.Above Land Surface'
'Tap of wino terminated allor below land surface requires a b,
variance in accordance with 1SA NCAC 2C.0110.
9. YIELD(gpm):_I METHOD OF TEST 0-2
10.WATER ZONES(depth):_ to
11. DISINFECTION:Type LOCATION FT H tLn
YP Amount Show direction and distance in miles from at least
12. CASING: t�i met Wall Thickness two State Roads or County Roads.Include the roa
From (� gt, %4 ttN?5qt numbers and common road names.
From To Ft. \\
From To Ft II W
13. GROUT: Deyty cy M 'al
m Fro To� l D Method
Front _
To Ft M I
14. SCREEN: Depth DiameterSize
Material
From To Ft. in. in.
From To Ft, in. dl )
IS- SAND/GRAVELPACK O-A
in.
Depth Size Material
From Tc Ft
From To Ft. �—
16. REMARKS: n
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
CONSTRUCTION STANDARDS AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO WE O i
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DA
Submit the original to the Division of Water Quality,Groundwater Section,1636 Man Service Center-RaleighrN' C
27699-1636 Phone No.[phone],within 30 days.
GW-1 REV.07/2001

309193
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDMDUAL)NAME,,(�print) ����t �•� \ `j , (�;—rn� /y� ry
WELL CONTRACTOR COMPANY NAME P MEklfe�Z\I�,E } _ CERTIFICATION#�pP/o3a--�•
lam( PHONE
STATE WELL CONSTRUCTION PERMIT#_
ifapplicable) AeSOCIATED WQ PERMIT#
ifapplicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELLLOCp1LB
Nearest Town: ( C Topo8rap11idLansetting
❑Ridge ❑Slope alley []Flat(Street Name, �km
Numbers,Cat unity,Su 'vision,Lot Na.,Zip Cade) (check appropriate box)
Latitude/longitudeof well location
3. OWNER: n
Address
.�+�-� (degreeshnioutadseconds)
F .)(Street to No.)
LatitudeAongitude source:❑GPS❑Topographic map
b
DEEM
(check box)
�C`iry• t e Zip Code `v 1 DR! .i IN (lr`
trot- — 3S From To Format nDescription
Am code-Phone munber
4. DATEED DRILLED
5. TOTAL DEPTH: Q r 0
6. DOES WELL REPLACE EXISTING WELL? YE 10 NO � --- ��
7. STATIC WATER LEVEL Below Top of Casing:MM T.
8. TOP OF CASING IS ' Noe"+"ifAbow Top of Cuing)
FT.Above Land Surface•
'Top of cuing terminated aUor below fond rurhee requires a
variance in accord a is�ritb 15A NCAC 2C.0118.
9. YIELD(gpm):1`�ME�HOD OF TEST CJ-�t-
10.WATER ZONES(depth):
WPM
11. DISINFECTION:Type LOCATION SKETCH ty
YP Amount :Zmbersr
di tion and distance in miles from at lea`Rt
12. CASING: pp(�a tt Wall Thickness tate oads or County Roads.Include the road
Ft.�_ r Wi t. �¢etfpal d common road names.
From �j�
From To FL \
From To Ft.
13. GROUT, Method
From D Tp g L M t
From To
14. SCREEN: Depth Diameter m Slot Sim Material
From To Ft. in. in.
Fro To Ft. in. in.
15. SAND/GRAVEL PACK
Depth Sim Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
CONSTRU ON STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE
SIGNAITIRE OF PERSON CONSTRUCTING THE WELL
TE
a
Submit the original to the Division of Water Quality,Groundwater Section 1636 Mail Service Center-Ralel lil
27699-1636 Phone No.[phone],within 30 days. gh, ,
GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
309207
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prlat) WILLIAM 13RADLEY LEWIS CERTIFICATION to 3369
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # f )837-9009
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential MunicipaUPublic ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water njection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/t,agd setting
Nearest Town:TERRY County CHEROKEE ❑Ridge ❑Slope Valley ❑Flat
MT.PLEASANT RD TO BERGER RD (check eppmpri box)
(Street Name,Numbm,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: JOHN W.NICHOLSON -- _ - (degrees/minme,/seconds)
Address 109 MCWILLIAMS DR ______-.- Latilude/longitude source:❑GPS❑TopograpWc map
(Street or Rome No.) (check box)
TERRY MS 39170 DEPTH DRILLING LOG
City o Town state Z.ip Codc - -- Pmm TO Formation Description
( )- 937-2300 0'TO 20'
_____ BROWN DIRT
Area code-Phone numb" 20AT0 40
4. DATE DRILLED 03/15/2005 -
5. TOTAL DEPTH: 245' 40'TO 60' GRAVEL
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 60'TO t00'___ _GRANIT— E -
7. STATIC WATER LEVEL Below Top of Casing: 5 100'TO 245'_ _ GRANITE
(I1Re"4"if Above'rop or C,Ring)
R. TOP OF CASING IS 1 FT. Above Lard Surface* — - - --- --
*TOP of cawhtA terathuted M/Or benow land surface require,w - -...__-.-___—__.—.._
varholw In accoriaace with 15A NCAC 2C.0111L
9. YIELD(gpm): 30 METHOD OF TEST AIR ----- --
10. WATER ZONES(depth): ---- -- — ------ --
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE pnraun� 100 ppM— Show direction and distance in miles from at least
12. CASING: Wall Thickoes. hro Stale Roads or County Roads. include the mad
Depth Diameter or WeighUEt. Mnlerial numbers and cormnon road names.
From 0 TO 100 Ft. 6 1/9' SDR 21 PVC
From To Ft.
Fmm To
13. GROUT: Depth Material Method (r
From 0 To 20 _ FL CEMENT GRAVITY
FrontFront �-
Y Y
To Ft. '�-�
14. SCREEN: Depth Di ameter S - M
loi Size -__ aterial 's
Fmm To Ft. in. -- ---From To Ft. in. _ in. _ _ M t
15. SAND/GRAVEL PACK: _ — --
Depth Size MaleTial
From To Ft. 5
From To FL ---_ -- Q,
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONS'1 RIICTT?D IN ACCORDANCE W1 I11 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THH-�A1T.4j/COPY OF IT IIIS�RE-CORD HAS BEEN PROVIDED TO TTIE WELL OWNER
SIGNATURE OF PERSON CONSTRU G'DIFWELL DATE
Submit the original to the Division of Wafer Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 3 0 9 2 0 6
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDiVIDUAL)NAME (prtat) DAVID F. MCKINNON CERTIFICATIONN2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. pRONE M (828)837-MM
STATE WELL CONSTRUCTION PERMrTN ASSOCIATED WQ PF,RMrTN
(if applicable) (if applicable)
1- WELL USE(Check Applicable Box):Residerltiaix Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pmnp Wate ln)ection❑ Other❑ If O(lter,List Use
2. WELL LOCATION: Topog hic/Land setting
Nearest Town: MURPHY Comity CHEROKEE_ ❑Ridge FZSlopc ❑Valley []Fiat
HAWTHORNE ESTATES (check appropriate box)
(Street Name,Numbers,community,subdivision.Lot No., Latilude/longitude of well location
3. OWNER: MATT BRYDEBELL ___
(degrees/minmea/aeconds)
Address P.O.BOX 1475 _ _ Latitude/longittide soutce:❑GPS❑Topographic map
(street or Rame No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or7'own State Zip Code From 'To Formation Des., ption
(828 )-494-5766 V TO 20' _ BROWN DIRT
Area code-Phone number 20'TO 80_ SANDSTONE
4. DATE DRILLED 03/22/2005 B&TO 505' GRANITE t9
5. TOTAL DEPTH: 505' -----
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO, 1 -- -
7. STATIC WATER LEVEL Below Top of Casing: 50
(Use"+"if Above Top or('acing) --- - Lill
8. TOP OF CASING IS I FT. Above Land Surface* — —
*Top of casing terminated attor belan,land surface requbw a —__.._— __
variance in sccordancewah 1SA NCAC 2C.0111.
9. YIELD(gpni): 2 METHOD OF TEST AIR
10. WATER ZONES(depth): 100',360' BIT SIZE-5.675
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount too PPM Show direction and distance in miles from at least
12. CASING: Wall'Ihickness two Stale Roads or County Roads.Include the road
Depth Diameter or Weight/Ft Material numbers and common mad names.
From o To 80 Ft. 6 18' SDR 21 PVC
From To Ft.
From To FL
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT GRAVITY
From To Ft.—
L -- _ ( `
14. SCREEN: Depot Diameter Slot Size Ma Reriat
From To Ft. in. in.
Fmm To Ft. in. in.
15. SAND/GRAVEL PACK: C IS WA
Depth Size Material
From To Ft.
From—To—
mmTo FL
16. REMARKS:
I DO HEREBY CERTIFY THAT"IRS WELL WAS CONS'IRUCTE:D IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY( F THIS RFCO HAS BEEN PROVIDED TO THE WELL OWNER i.
SIGNATURE OF PERSON CONS IRUCTINO THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 3 0 9 5 8 9
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDWIDUAL)NAME (print). DAVID F. MCKINNON CERTIFICATION#2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE # (tag)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
❑
Monitoring❑ Recovery Heat Pump Water njection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo iaphic/Land setting
Nearest Town: 17QASS ioq.9l,-I County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
1484 FLOYD STALCUP RD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latimde/longilude of well location
3. OWNER: JEFFREY&MARGARET SHARP (degrees/minutes/seconds)
Address 16406 106TH TERRACE NORTH Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
StaPITeR , FL 33478 DEPTH DRILLING LOG
City or Town State Zip code From To Formation Description
746-1631 V TO 125' DIRT/SLATE MIX
Area code-Phone number 4. DATE DRILLED 03/25/2005 125'TO 245' SLATE/GRANITE MIX
5. TOTAL DEPTH: 245'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50' FT. AA
(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. 'O
9. YIELD(gpm): 50 METHOD OF TEST AIR
10. WATER ZONES(depth): 130', 180' jt
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount too PPM Show direction and distance in miles from eVtleast .
12. CASING: Wall Thickness two State Roads or County Roads. Include the roar
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 125 Ft. 6 1/8" SDR 21 PVC
From To Ft. Q0
From To F[.
13. GROUT: Depth Material Method t-0�
From 0 To 125 Ft.CEMENT GRAVITY
From To Ft. a
14. SCREEN: Depth Diameter Slot Size Material 7a -
From To Ft. in. in.
From To Ft. in. in. L —
15. SAND/GRAVEL PACK:
Depth Size Material From To Ft.
o =
Fmm To Ft. /11kjrTiUS
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`H>ASS BEEN
/PROVIDED TO THE WELL OWNER
Ati �1/� �i� , �t,ti 3-31-os
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
309588
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (pdnt) WILLIAM BRADLEY LEWIS CERTIFICATION 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential MunicipaVPublic ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Plump Water njection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge 00SIope ❑Valley ❑Flat
CAMP CREEK RD TO END OF PAVEMENT,IST DRIVE ON RIGHT (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Tut No.,Zip Code) Latitude/longitude of well location
3. OWNER: BRIAN MILLER C/O MIKE FRADY (degrees/minutes/seconds)
Address 2819 SUNNY POINT RD Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or town state Zip code From To Formation Description
644-5385 0'TO 40' RED CLAY/SANDSTONE
Area code-Phone number 40'TO 60' GRANITE
4. DATE DRILLED 03/24/2005 60'TO 285' GRANITE
5. TOTAL DEPTH: 285'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ,y
7. STATIC WATER LEVEL.Below Top of Casing: 100' FT. Yi
(Use'+"if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface* y*Top of casing terminated attor below land surface requires a -g .14
variance in accordance with 15A NCAC 2C.011S. �;T
9. YIELD(gpm): 50 METHOD OF TEST AIR t
10. WATER ZONES (depth):
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 60 Ft. 61/8" SDR 21 PVC
From To Ft.
m Fro To Ft. c4mo
13. GROUT: Depth Material Method C�
From 0 To 20 Ft.CEMENT GRAVITY PPk.
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To FL in. in.
15. SAND/GRAVEL PACK: a t t
Depth Size Material (A \!e'
From To Ft. fl
Fmm To FL r
-
16. REMARKS: —
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TIIA^�COPY OF THIS RECOr S BEEN MOVIDED TO THE WELL OWNER o
SIGNATURE OF PERSON CONSTRUC THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Malt Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD �' 7
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR pNiuvroUAL)NAME (priot) WILLIAM BRADLE-LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING
PHONE # (828)837$008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential) ( MumcipaUPublic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Wate Injection❑ Other❑ If Otter,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE 'dlRidge []Slope ❑Valley ❑Flat
TARHEEL-FOX RUN 2-CORNER OF SHADOW&SHERRY LN /C (check appmpriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: DAVID RITZ/BILLCARRINGER (degrees/minutes/seconds)
Address 1151 WEST U.S.HWY 64 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
cay or Town State Zip Code From To Formation Description
8( 28 )-837-3002 O'TO 20' RED DIRT
Area code-Phone number 20 TO 40' BLACK/RED SANDSTONE
4. DATE DRILLED 03/29/2005 40'TO 60' BLUE SLATE
5. TOTAL DEPTH: 385' 60'TO 385' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use`+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface" ru
*Top of casing termhtated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 20 METHOD OF TEST AIR
10. WATER ZONES(depth): 280'
LOCATION SKETCH p
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at fts[
12. CASING: wall Tlriclatess two State Roads or County Roads. Include the road S
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 60 Ft. 61/8- SDR 21 PVC
From TO Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 TO 20 Ft CEMENT GRAVITY Qj
From To Ft. Q
14. SCREEN: Depth Diameter Slot Size Material
From TO Ft. in. in.
From To Ft. in in. U
15. SAND/GRAVEL PACK: N
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL a
CONSTRUCTION STANDARDS,AND THAT COPY OF S RE ORD HAS B PROVIDED TO THE WELL OWNER 7n 5 '
SIGNATURE OF PERSON CONSTRWrING THE WELL DATE c-
Submit the original to the Division of Witter Quality,Attn:Information Management,1617 Mail Service Center- g
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days.
GW-1 REV.09/2004 -

WELL CONSTRUCTION RECORD 3 0 9 5 8 6
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVID F.MCKINNON CERTIFICATION 92411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE a j828)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITN
(if applicable) 10000001 (if applicable)
010001111100
1. WELL USE(Check Applicable Box):Residential �Mumcipal/Public❑ Industrial❑ Agricultural❑
❑Monitoring Recovery ❑ Heat Pump Water Inje tion❑ Other❑ If Other,List Use
2. WELL LOCATION: Top raphic/L and setting
Nearest Town: MURPHY County CHE OKEE ❑RidgeSlope ❑Valley ❑Flat
TARHEEL WEST-247 DREAM MAKER LN ( heck appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip C e) Latitude/longitude of well location
3. OWNER: GRAM&WENDY FARBSTEIN (degrees/ndnmes/seconds)
Address 247 DREAM MAKER LN Latitude/longitude source:❑GPS❑Topographic map
(Sheet or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town Stale Zip code From TO Formation Description
8( 29 )-837-9654 O'TO 80' RED CLAY/SANDSTONE
Area code-Phone number 80'TO 320' TALC
4. DATE DRILLED 03/24/2005 320'TO 405' GRANITE
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7. STATIC WATER LEVEL Below Top of Casing: 50'
(Use"+"if Above Top of acing)
8. TOP OF CASING IS 1 FT. Above Land Surface* �t
-Top or casing terminated atlor belwr land surface requires a "O
variance in acmrdancewith 15A NCAC 2C.0118.
9. YIELD(gpm): 5 METHOD OF TEST AIR
ut �
10. WATER ZONES(depth): 200',300'
LOCATION SKETCH Cil
It. DISINFECTION:Type CHLORINE Amount 10 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickne two State Roads or County Roads. Include the road
Depth Diameter or WeighUFt, Material numbers and common road names.
From 0 To 80 Ft. 6 1/8" SDR 21 PVC
From To Ft. n
From To Ft.
13. GROUT: Depth Material Method Pit
From 0 To 20 Ft.CEMENT GRAVITY _ �Q
From To FL Q
14. SCREEN: Depth Diameter Slot Size Material /a
From To Ft. in. in. U q9
From To F[. in. tn.
15. SAND/GRAVEL PACK:
Depot Size Material! /
From To Ft.
From To FL ` P"_C /'11N2- ('D
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRL CTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF 71 IS RECORD HAS BEEN PROVIDED TO THE WELL OWNER�
01C sls,tt-)t_
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,A n:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 39 days. a�st
GW-I REV.09/2004

WELL CONSTRUCTION RECORD 3 10 "
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) .WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural ElMonitoring❑ ❑Recovery Heat Pump Water njection❑ Other❑ If Other,List Use
2. WELL LOCATION: Top R��phic/Land settuig
Nearest Town: MURPHY County CHEROKEE ❑Ridge dope []Valley ❑Flat
CLIFF RAPER RD TO DOVE HOLLOW (chm appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: ROBERT$JENNA MERRILL (degrees/minutes/seconds)
Address 1497 DOVE HOLLOW Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.)_ (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Codc From To Formation Description
8( 28)-361-0873 0'TO 20' RED DIRT
Area code-Phone number 20'TO 40' BLUE GRANITE
4. DATE DRILLED 03/23/2005 40'TO 245' GRANITE
5. TOTAL DEPTH: 245'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 75'
(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 requites a
variance In accordance with I5A NCAC 2C.0118. t
9. YIELD(gpm): 12 METHOD OF TEST AIR
10. WATER ZONES(depth): o
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two Slate Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road name
From o To 40 Ft. 6 1/8" SDR 21 PVC
From To Ft. r a>
From To Ft. )1a
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material U L CIE:
From To Ft. in. in.
From To Ft. in. in. P
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.-
From—To—Ft. '�b)AA& s
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 P OVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTINOM WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center- --
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days —`
GW-1 It4y 09/20

WELL CONSTRUCTION RECORD 3 0 9 5 8 4
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION$13368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE # (?,A)837-BOOB
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (iC applicable)
1. WELL USE(Check Applicable Box):Residential 1�J Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water n ection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MARBLE County CHEROKEE ❑Ridge Plope ❑Valley ❑Flat
HEDDEN RD TO CROSS CREEK (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: SITYLAN 8 LISA MOSS (degrees/minmes/seconds)
Address 178 PALMER LN Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
MARBLE NC 28905 DEPTH DRILLING LOG
City or Town State Zipcode From To Formation Description
(�- 4.5S -$3C)0 O'TO 20' RED BROWN DIRT
Area code-Phone number 20'TO 120' BROWN/rAN SANDSTONE
4. DATE DRILLED 03/2l/2005 120'TO 148' MARBLE
5. TOTAL DEPTH: 165' 148'TO 165' MARBLE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 75' 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 r'a
variance in accordance with 15A NCAC 2C.0118. Im t'f
9. YIELD(gpm): 30 METHOD OF TEST AIR -o—�
10. WATER ZONES(depth): 1
LOCATION SKETCH uI
11. DISINFECTION:Type CHLORINE Amount 10O PPM Show direction and distance in miles frott81 leas
12. CASING: Wall Thickness two State Roads or County Roads. Includ6Ae rod
Depth Diameter or Weight/Ft. Material numbers and common road names.
From O To 148 Ft. 6 118' SDR 21 PVC 'i
From To Ft. w� J
From To FL
13. GROUT: Depth Material Method Sze
From 0 To 20 FL CEMENT GRAVITY
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. l IE
From To Ft. in. in. f
15. SAND/GRAVEL PACK:
Depth Size Material 0%
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL ='
CONSTRUCTION STANDARDS,AND THAT A COPY O"REC HAS BE PROVIDED TO THE WELL,OWNER
SIGNATURE OF PERSON CONSTRLFING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center- csl --
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I.RVV.09/2004

WELL CONSTRUCTION RECORD 30
9583
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prinl) DAVID F.MCKINNON CERTIFICATION$12411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT9
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial El Agricultural❑
El❑ Recovery Heat Pump Water njection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE Ridge ❑Slope ❑Valley ❑Flat
RADFORD RD TO MI-PO DRIVE,WELL#1 -TOP OF RIDGE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: DAVID WATSON (degrees/minutes/seconds)
Address P.O.BOX 1516 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
828 -361-5289 0'TO 85' RED CLAYGROWN SANDSTONE
Area code-Phone number 85'TO 805' GRANITE
4. DATE DRILLED 03/14/2005
5. TOTAL DEPTH: 805'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 550' FT.
(Use"V'if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface"
-Top ofcastng teradnated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 1 QUART METHOD OF TEST AIR 1
10. WATER ZONES (depth):
LOCATION SKETCH o
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles fromt leail
12. CASING: Wall Thickness two State Roads or County Roads. Include the ns
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 85 Ft. 61/8" SUR 21 PVC y`
From To Ft.
From To Ft. �� �'O 0-
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in, in. LcL�
15. SAND/GRAVEL PACK: p3
Depth Size Material 5l
From TO Ft.
Fmm To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A CO Y OF THIS RECORD HA BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE -
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days.
GW-I RED.-09/2004" _
a

WELL CONSTRUCTION RECORD 3 O 9
582
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVIDF. MCKINNON CERTIFICATION$12411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential Mui icipal/Pubfic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water niection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge ❑Slope ❑Valley XFlat
RADFORD RD TO MI-PO DRIVE,WELL 92-ON RIGHT (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: DAVID WATSON (degrees/minutes/seconds)
Address P.O.BOX 1516 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28 )-361-5289 0'TO 90' BROWN SANDSTONE
Area code-Phone number 85'TO 805' GRANITE
4. DATE DRILLED 0 3/1 812 0 0 5
5. TOTAL DEPTH: 405, o
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO �r(
7. STATIC WATER LEVEL Below Top of Casing: 75' FT. i
(Use"+"if Above Top of Casing) ey,
8. TOP OF CASING IS 1 FT. Above Land Surface* t
-Top of casing terminated at/or below land surrace requires a LA
variance In accordancewith ISA NCAC 2C.0118.
9. YIELD(gpm): 15 METHOD OF TEST AIR
10. WATER ZONES(depth): 140',300'
LOCATION SKETCH
It. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 90 Ft, 6 118- SDR 21 PVC
From To Ft.
From To I't V0 DR
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY
From To Ft. \
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. a -
15. SAND/GRAVEL PACK: 13
Depth Size Material
From To Ft.
From To Ft. F c9
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL °r
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CON RUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD (1 � 310508
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVID F.MCKINNON CERTIFICATION#2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMTT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential MunicipM)ublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE []Ridge l4Slope ❑Valley ❑Flat
HAWTHORNE ESTATES (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeROngitude Of well location
3. OWNER: MATT BRYDEBELL (degrees/mimdes/mconds)
Address P.O.BOX 1475 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
8( 28 )-494-5766 O'TO 20' BROWN DIRT
Area code-Phone number 20'TO80' SANDSTONE
4. DATE DRILLED 03122/2005 80'TO 505' GRANITE
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO IX
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 easing terminated allor below land surface requires a
variance in accordance with ISA NCAC 2C.0118. -p
9. YIELD(gpm): 2 METHOD OF TEST AIR
10. WATER ZONES(depth): lo0',360' BIT SIZE-5.LOCATION
N
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 160 PPM Show direction and distance in miles frorrrdt leash
12. CASING: Wall Thickness two State Roads or County Roads.Include lie rot
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 80 Ft. 6 18' SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft CEMENT GRAVITY
From To Ft. 1 fr
14. SCREEN: Depth Diameter Slot Size Material n
From To Ft in. in. r S
From To Ft. in. in. t5 WAY
15. SAND/GRAVEL PACK: 4) apA
Depth Size Material
From To FL
From To Ft. C�
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COPY F RECORD HAS BEEN PROVIDED TO THE WELL OWNER
�,���
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center- ^'
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09W04

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
311 � � Q
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # 0&4)837.8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential X Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: AluJZ014 ! CountyCHEROKEE ❑Ridge ❑Slope AVallcy ❑Flat
PRINCE ROAD(NEXT TO A.B.LEDFORD) (check appropria box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: TOM BARRIERE (degrees/minutes/seconds)
Address 2269 TROPICAIRE BLVD. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
,V,A;f tpdr2r 1 FL 34286 DEPTH DRILLING LOG
City or"Town State Zip Code From To Formation Description
(94J!)-809-5678 0'TO 20' BROWN DIRT
Area code-Phone another 20'TO 40' SAND/GRAVEL
4. DATE DRILLED 05/1112005 40'TO 63' GRANITE -
5. TOTAL DEPTH: 365' 63'TO 365' GRANITE -
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO _
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 termhrated at/or below land surface requires a
variance in accordance wkh I5A NCAC 2C.0118. -
9. YIELD(gpm): 6 METHOD OF TEST AIR =
10. WATER ZONES(depth): 300'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles fromat least " -
12. CASING: Wall Thickness two State Roads or County Roads. Include the road ,
Depth Diameter or Weight/Ft. Material numbers and common it names.
From o To 63 Ft. 6 1/8' SDR 21 PVC (/X
From To Ft. t,y
From TD Ft al3
13. GROUT: Depth Material Method pal
From 0 To 20 Ft.CEMENT GRAVITY 1 �w
From To Ft.
AD
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material '40
From To Ft.
From To Ft.
16. REMARKS: CA-r'l%j' M t2D
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND A Y OF THIS CORD S BEEN P VIDED TO THE WELL OWNER
5/z-o5
SIGNATURE OF PERSON CONSTRUC WELL DATE
Submit the original to the Division of Water Quality,Mtn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004

WELL CONSTRUCTION RECORD ry 1 1
North Carolina Department of Environment and Natural Resources-Division of Water Quality J 1 1 `) 9 9
WELL CONTRACTOR(INDIVIDUAL)NAME (Print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential)Q Municipal/Pubhc❑ Industrial ❑ Agriculttual❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: /Kto-pk1/ County CHEROKEE Ridge ❑Slope ❑Valley ❑Flat
"3RDWELL" BELOW POND (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudetlongitude of well location
3. OWNER: JAN LUKENS C/O STILES ENTERPRISES (degrees/minutes/seconds)
Address 419 WELLS RD Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
/NM[R13t k 1 NC 28905 DEPTH DRILLING LOG
city or Town state Zip Code From To Formation Description
8( 28 )- 361-0633 0'TO 20' BROWN SLATE
Area code-Phone number 20'TO 27' BLUE SLATE
4. DATE DRILLED 05/11/2005 2T TO 505' SLATE
5. TOTAL DEPTH: 505'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+^if Above Top of Casing)
8. TOP OF CASING IS I FT.Above Land Surfaces
•Top of casing termbrated 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): LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 27 Ft. 6 1/8" SDR 21 PVC
;a
From To Ft �ev�
From To Ft. VO V.
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. 3�
15. SAND/GRAVEL PACK:
Depth Size Material '-"From To Ft. r
From To Ft
16. REMARKS: 6/7
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RE ORD HAS BE PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCONGrIIE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management, 1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 311598
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION$3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE [phone]
STATE WELL CONSTRUCTION PERMIT$ ASSOCIATED WQ PERMIT$
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential P( Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: PlvKPHY County CHEROKEE Midge ❑Slope ❑Valley ❑Flat
UNAKA PAST HORSE FARM-TOP WELL @ HOUSE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: JAN LUKENS C/O STILES ENTERPRISES (degrees/minutes/seconds)
Address 419 WELLS RD Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
/►'i/4R13L t= � NC 28905 DEPTH DRILLING LOG
city or Town State Zip code From To Formation Description
8( 28 )-361-0633 0'TO 20' BROWN DIRT
Area code-Phone number 20'TO 23' BLUE SLATE -- _
4. DATE DRILLED 05/02/2005 23'TO 1205' SLATE °
5. TOTAL DEPTH: 1205'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: — 5
(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.011a _
9. YIELD(gpm): METHOD OF TEST AIR ^'
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least 5
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 23 Ft. 6 1/8' SDR 21 PVC
From To Ft. p1
From To Ft. �y
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT GRAVITY r,4tL,�
From To Ft.14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To FL in. in.
15. SAND/GRAVEL PACK: t�
Depth Size Material 11
From To Ft. G
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A �YOF THIS RE ORD S BEEN PROVI TO THE WELL OWNER
5—.2 —QS
SIGNATURE OF PERSON CONSTRUCTING 7WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 3 1 1 5 9 7
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (pdnl) WILLIAM BRADLEY LEWIS CERTIFICATION N 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING NAD PUMP CO.,INC. PHONE N [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITN
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Mumcipal/Pubtic❑ Industrial ElAgricultural❑
❑Monitoring❑ Recovery Heat Pump Water njection❑ Other❑ if Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: tXt kPF\i County CHEROKEE ❑Ridge ❑Slope ❑Valley *lat
UNAKA PAST HORSE FARM-BOTTOM WELL @ METAL BLDG. (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: JAN LUKENS C/O STILES ENTERPRISES (degrees/minutes/seconds)
Address 419 WELLS RD Latitude/longitude source:❑GPSOTopographic map
(Street or Route No.) (check box)
Mt4RIi1 F NC 28905 DEPTH DRILLING LOG
city or Town State Zip code From To Formation Description
8( 28 )-361-0633 V TO 20' RED CLAY
Area code-Phone number 20'TO40' SANDSTONE
4. DATE DRILLED 04/26/2005 40'TO 60' DARK BLUE SLATE
5. TOTAL DEPTH: 505' 60'TO 505' SLATE r
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 150 Fr.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing tennhnted at/or below land surface requires a I �"
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 3 METHOD OF TEST AIR
10. WATER ZONES(depth):
LOCATION SKETCH { _
11. DISINFECTION:Type CHLORINE Amount too PPM Show direction and distance in miles from qt least j
12. CASING: Wall Thickness two State Roads or County Roads. Include the road=---7
Depth Diameter or Weight/Ft. Material numbers and common road names. --:--
From 0 To 60 Ft. 61/8- SDR 21 PVC
From To Ft.
From To FL eu Avid
13. GROUT: Depth Material Method
Fmm 0 To 20 Ft.CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To FL in. in.
15. SAND/GRAVEL PACK: � 1�
Depth Size Material
From To Ft.
From To Ft.
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 EEN PROVIDED TO THE WELL OWNER
gym- S—�-as
SIGNATURE OF PERSON CONSTRFTTNG THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mau Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004

WELL CONSTRUCTION RECORD 311594
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDTVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING NAD PUMP CO.,INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential P( MunicipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land se,`r1IY`g-_
Nearest Town: MURPHY County CHEROKEE ❑Ridge $Slope ❑Vai1 at
OGREETA TO OLD JOHNSON RD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well 114"�
3. OWNER: CHRISTEL FARMER (degrees/minm es/seconds
$
Address P.O.BOX 696 Latitude/Iongitude source:❑GPS❑Tbpojapluc map
(Street or Route No.) (check box)I , I '
MURPHY NC 28906 DEPTH DRILLING LOG—
City or Town State Zip Code From To FomlatiOIl Description --
8( 28)-835-7336 V TO 20' RED CLAY
Area code-Phone number 20'TO40' SANDSTONE
4. DATE DRILLED 04/21/2005 40'TO 50' GRANITE
5. TOTAL DEPTH: 185' 50'TO 185' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 62
(Use`+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Lam 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): 60'-W ROD, 140'TO 160'ROD
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two Stale Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. p4D
From 0 To 50 Ft. 61/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY
From To Ft. b
14. SCREEN: Depth Diameter Slot Size Material
From TO Ft. in. in.
From To Ft. in. in. p
15. SAND/GRAVEL PACK: t
Depth Size Material `s
From To Ft.
From To Ft.
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 KORD HAS EN PROVIDED TO THE WELL OWNER
SIG14ATURE OF PERSON CONS POCTBQG THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD q
North Carolina Department of Environment and Natural Resources-Division of Water Quality 3 1 1 5 e9 5
WELL CONTRACTOR(INDWIDUAL)NAME (print) DAVID F.MCKINNON CERTIFICATION#2411
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`{ Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water n ection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE Ridge ❑Slope ❑Valley ❑F19 !,
BELL HILL RD TO WALLACE RIDGE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: LENNY GREENBURG (degrees/mimues/seconds) -
Address 61 DUSTY LN Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box) _
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town Stoic Zip Code From To Formation Description
8( 28 )-837-9495 0'TO 25' RED/BROWN DIRT
Area code-Phone number 25'TO 40' GRANITEISET CASING
4. DATE DRILLED 05/03/05 40'TO 195' GRANITE
5. TOTAL DEPTH: 195'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS I FT. Above Land Surface'
"Top of casing terminated e#or below lend surface requires a
variance in sccordancewhit 15A NCAC 2C.0118,
9. YIELD(gpm): 50+ METHOD OF TEST AIR'
10. WATER ZONES(depth): 190' LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount !DO PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 40 Ft. 61/8" SDR 21 PVC D
From To Ft. Q
From To FL y 1
13. GROUT: Depth Material Method mil✓ ^T t L 1- t kJ4!<q�Q1e(,
From 0 To 20 Ft CEMENT GRAVITY
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From TO Ft. in. in. �.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. tvJ Wei_
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 TIES RECORD HAS BEEN PROVIDED TO THE WELL OWNER
5._y-��
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mall Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004

WELL CONSTRUCTION RECORD
�� 3115J3
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (paint) DAVIDRMCKINNON CERTIFICATION 2411
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' Municipal/Public ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water nJection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE []Ridge biSlope ❑Valley ❑Flat
TARHEEL PROPERTIES TO WARREN DR TO LOBLOLLY check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: J 8 R(RICHARD KNEE) (degrees/minutes/seconds)
Address P.O.BOX 1126 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip code From To Formation Description
8( 28 )-837-7817 0'TO 80' RED DIRT
Area code-Phone number 80'TO 100' BOULDERISURFACE WATER
4. DATE DRILLED 05/02/05 100'TO 120' BROWN SANDSTONE
5. TOTAL DEPTH: 600' 120'TO 140' GRANITE/SET CASING
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 140'TO 320' GRANITE
7. STATIC WATER LEVEL Below Top of Casing: 97 320'TO 340' GRANITE/TALC MIC
(Use"+"if Above Top of Casing) 340'TO 380' GRANITE
8. TOP OF CASING IS 1 FT. Above Land Surface; 380'TO 400' GRANITE/TALC MIX
•Top of casing terminated at/or below land surface requires a 400'TO 600' GRANITE
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 4 METHOD OF TEST AIR'
10. WATER ZONES(depth): 418' BIT SIZE 6.105
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or WeighUFt. Material numbers and common road names.
From 0 To 140 Ft. 6 1/8" SDR 21 PVC
From To FL
m �vA( c✓ ��
Fro 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 Tc FL in. in. n'
15. SAND/GRAVEL PACK:
Depth Size Material -r
From To Ft.
From To Ft.
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)2ECORD VAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
1JoIIh l'nl olina - 1)rpallntcl;t of 8nvinnuncnl and Nntul nl Rcsotuccs-I)ivisiou of Wnlcr(lonlity- Olanndtcntcr Section
(� �� `cFa unCA I n)N nQ1��/
tt'FIJ.CIINIIIACIURUNUn IUIIAI.)r1AhIE tilllop_ Qym—esS-.-_.'.`�"'^'<'++�'-�-`-�
rlluilr,
"ELL CoN I IrACIun CImrAN1'NAPIlirrt-���-----'----
ASSOCIAI VO I N) FE10111M
S fAl E R-FLL CLANS I IIrrCIIUN I'EIUIITN_—_____._------- if n r dicablc
I, 11'pl.l,USIP (Chrck Applicable Itot): Rcaidcoliol ISY blunidpn1/1'ulrli U In(lushial 11 Alt icullotal U ---
t`Inuilnl ing U Rccovcty LI Heal I'uugr Warr' Injection U Other U If Olbcr,I,isl Uee
), \VPl.l, II)CA 11011: 'fopoglnp6ic/I.nnd .^.cllin);
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(dw,it nppaprinle b••r)
Lnliluddlongi title UFINClllocnllolt
(SU1r111nn1F.NvnJ•^n,Cnnmuniil'.$nbJi,ision.l.•I ILr.,7.ip l�rvlr) J5�
11 (deererdminnln4evnnl•)
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/ I. pp (,heckN")
fio) gr
J)LL171 UtjILLII!(i_LOIi
L II �! �����------ FvnnnlionUcsctipliuu
—_—�'iiy or 1 nwu $lei! 7.ip Co•Ir
nirn r�•I. rLnn!numter � _ �� /1 r A�r �'e --_--
_
G. Itltl'S \\'lil,l, Ilpl'IAl'P. I!SISI IIJG \VI'1.1'! YI!S LI IJO UJ- _—
7. S I-A I IC WA I Elt LEVEL ltclow'fop of(':reing: ._
(U•r"1' Ir nh,•rr l�,h of 1'n•iopl —_-----�:a----
g I IhI• ltl" ('/\SIh,IJ IS -_--_1._-- PI'. Above I.n nl Stuntec' ---
•'I rp rf rndng In rnlnnlyd nl/••r Lrinn Wul union rrgnL rr
r nrinnre In•[andu¢a ni1L m%NCAC 1r'•ntlM.
o, l ll° 1) 3Q.---nllu l lou(0'fli f_kIL- --- -- — ---
Iif. \VAI ISR ZI)rJES (dcpdr): ----- — LWA1101: SKL-VA1.
` Auuuwl__1as Sllmv dileclion and distance in miles lion) It Ica;1
I I. 1)ISItJI°ECrIOrI:'f}pc��iT�p�IP hvo Stale Itonds or Couoryltunds. Include Iltc road
12. C'/\SING! and cuUWwn to, nalnc9•
\Nall'I bickncss
Dvill Uinnielct or\VcigtlVfl, bintclial ntnul)crs
1'Into_�.— Io_55-- I'I_I?ic5— - ��c`— Leo ¢aY�s{ctY
171vol To
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1). GROUI : 14p1t1 b`drlinl
fletn_ 0__'fo—
Plout_.3 'fo-.aM—f1.�j.PJTtOyx: �--
Id. MII-T•l1; hepllr I)iautcicr Sloltiizc pdntcnnl
I"Ioi❑ fn 1'1. in. ------ in. — - --
15, rANlvGItAVI:I-VACk
I)rptlr $irr btnlciild
16,
-----
hnm
I ,
IIO I II 1•I:1)1 (-fptJIFY 1IIA'I"I IIIS R'I'1.1,WAS("ONS HUR I II.O IN ACCOIU)AIJCI;tVll11 ISA P1CAC 2( •
CONS I P.UCI IOtJ 5 I"ntJDnRbS,AND'l l lAl"A COPY
OI""rill S)tECORD HAS IIEON PROVIOEO'I F)""'' WI 1,L o\\I IEIt
/ a(aJnJul!plrfi'pl!sl)r,cvNsrl(ucrltJOvlliwel,l, uAn.
SolriniI IItc nl l;_InA to tlic hit own o1 MN or I)nnlitp,(:1 ound(vnlcr 5ccllvur Ifi1(i pinll Scrvll:c(-(,Nrl I!11r V'll"ll)t)III
i-1,"^ )tr/ !'!'.•nr r',• !ninl�•11 t_.I,t-•Ifhl❑ -r!t 1..y.[.

_ �
wELL CONS'I'I(UCI'AON RECO19 31t 64
I4o1111 C:n of ina - Urpnitolclit of III Iviroulucul and 14111 lai Itesouuttccs o- Uivisio of Wnict Qtrnlily- orlwld"tcr Sccti��d�
/�eece -- '(:Fit I I r I CA 1 1 Or In
n-rt.i,CON1itAClint IINUIVIPIIAI,)N,\a1 F. In loll _ - ----- —
11V1.1,CON I IIACI(fit COMIYVIV NAAIF—_�/.(__`/e�-------------------
A55(ICIAI FI/ %Vq 1'F.INIIIM
S rAIF t1 F.1a,('NNCIIIIlCIIIIN I'EIIPIIIH_--_______------- ifn �dicnbic
Of❑ • h(:11d< .. ..
I. iudhnal CI
\\'L•I I.tilt: ((-Trek Applicable Ikon): Residential I_`l�hluuicipnl/Public U InJusilial Cl Alp
tdollilolinF LI Recovcly I_I Ilcal fully 1Va1cr IljrClion u Ulhcn IJ 11 Otllct, List Ilse_ ---
2. R'PLI,LO('A11011: 'Yopogl4plliJ1.110 llini;
IJRillgc LlSlupc LIVnllry I_Itlal
IJcmcst'llnrre -----
(rL<rk nrproprinrr;F••.)
[[
-- il f, %iniv¢,1 o I ln.,71p CIAO ladiludr/IUn6•iludc of vvCll it ot�l
(Sb«I rinnir,Nninl,n.. tnrnlnn
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� �- I_alilu lc/lungiludc soulcc:Cl(tl'SU fupopinpbic nl p
(chc(ki••m)
( "<"""""�<II") /• 1>lL'lJl Ui(lu.lrlu-I_ut;
MIA[ �1/G._Z�g�6. ----.__---- � Fouualion Oc,clipliun
------ 74 Cv.1, Flom Fo
n rn nvl -I L ne nnnd•er�„ �/" J S,G' 1.�6 —�•Aj,j4.9
5, IM'AI —
(. OIll's 1\'I?1.1, lil'1'LAl'h. l°.\ISfIIJU 1V1 1.1 7 ) BS LI NO W
I° ' -
7. S hA lIC 1VAll;R LI;VISL Ilclow'I up of ( 1 Ir I �d _ I•
—
(ll.<"r"If ALnv 1-qn l l nrup)
OI't'ASIIJI IS Above I.mul Sul lncc' _
•I��p^I ndny loon nlrJ nl/�.r1 1 Ln,l tnr hrr rtgnLnn — ,-- I ,-��
,nrinrt<Inn<raltlnn¢nlnr ISA NIA('ll'llllfl. ,¢
o. 1 It•I I) Ip),nlp _ _—h11;1IIUD UI I t S 1'-1 // --- - -_��
LQC<AIIUIJSYI fCjl'
Auunnd __�2w — Show dilccliun and dislmlcc in milrH Gulp nl Icsa
11. I)ISIIJFI:.0 l I014:T)pe�T Wall lbickncss 11vo Stale Ilontls ur Connly Roods. Include the fond
12. CASING: uulnbcls gild couunon road nanics.
I
). dI Uinulc(cr I)F IV k,hL1:1. h Ic ial
I lnm D—To G U PI._ G.•1s' '?21 Ci
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I)O I IFI'.f 11Y CF P,I II°V IIAAl"I IIIS 1VF1,1,1VA';('ULISllllll"I ItU IN ACCORUAI WE ll11 15A MAC 2C•\V11.1.
COtJS 10.U("I it)IJ S I ANUAILUS,AND'1I IA I'A COPY OI°'I-Ills RECORDI HAS BEEN 1'ROVI000'l0'I ��'.Il�}\�'I tI:R
(II(I!OF 11ITSON CONS 1RUCllN(I'l III!WALL UA'II.
Sulnuit lhr III Igilyd ((I file V11 i11on III Wn(ri Ouglily,Gloundtvnle,Section, 1636 h1nllScrvlce C(lNrl I!I IV'1111?Inll
P!v. (nl,•I 7111:!I,

WELL CONS'lRUC ION 1ILLCORD 311663
IJollb Ca Iof ina - Ilr1'al II ne ul of 1'11vi 10 III I I ell I null Na I IIlaI Itcv oil I cca-DivipioII of Wit ICI(Quad ily- QIII00dlvn l cr See I it)11
IVFLI,CON IRAC 1()R IINIrIN IMIAi.)N,\a1E (1n 1iI)— ay,
Q-S- ����-�-�- 'CEI(I If ICA lIU11M�v�
I\'FLL CIN I unCI Olt(-opu•ANV NA n I yl��21L. . P.1.._-c�-G��:.�A�-----------rnuNr. n (vav)Sf1f-1497
S I I F.NI ELL CONS I It"C I I Or'I'F.IUIII q_________-----ASSOCIA I Rn 1VI)ITRAII I0
if n • 'lit nhb,) if n r .1 ca I c
I. lVI'I.1, 1IS11. (Check Applicable Ilea): Rcsidenlinl U IoJu^Ilial IJ nglicullultd U
Nlouilotiog U lIccovcly LI I eM I'unlp 1Valri Iejcclioll U OIdler C1 If OIIIcr,I-ipl IJac_ .
2. XNT1 1, 1 OCA 11011: 7bpogrnphic1l.me1 Scllillg
IJcalcct'fo,en'jYjUC�wI 1_L_-____p(1ounl)' l_ISlope LlVallry LlPlat
k Nalhwlt._R+cLt old Zell . (rlmtk n,•,nn,n f%I Crr
Lnliulddlongilude of«eIl lucnlion
(Slrrel Onint•1 ran bra.0.... roil/'.Snl•Jivkinn,1'.]I ,,i i,,Mule) � W- G , Q H
Address I,alihuldluugilude sooIcc:LI(;P5❑I 1
u m:q)
(.r,Urrl ur 1!•Ale Nn.)
N�Z qo6
f'ily or I n n $Isle 1 l - '--- Flout fl, 1'ouealiouUcsclipliun
7i,Cndr
1
10
Arrn tad•- 1'h.ne nnmbrr -1�' _ 'S�� -
A. hell? ORILI 1:1) �i- l�_�.S__-- 5..f�- -
s, IIIfAI- 1)17PIII'__IIoS.___._-.._ . __ . —
(. Il()L:S \VISLI, Illll'LA(T FXIS-IIIJG WH L? )'I.S U 140 Itl- _
7. S I"AIIC WA I IA I.I:Vlil, llclow'fop of Cnsing: -- CO.- 14. {
(llrr"f"If ALncr 1,q,of 1'n•inp) _—_ N •��
g• 'I of, (ll' CASING 1 ;__�_J..— 11'. Above I.nod Sullilcc' �_—
•'1 rp nl n,b,p Irnnlnntrd nl.hn brinn Irnd anlnrr mpJr rr• O
ell
,nln,tr In•t tnldn,R nhlr IS,\N('AI'II',IIJ ip.
_—�-
10. NVA I ER ZONES (depth):
Automit` twolS Suite
RomI end distance o utilcs (lode n(e [ol
I. UISINI'I'.0 f IUN:'f}po � two Slalc Roads or Comely ILoada. Include Ulc load
12. CASINO: Wall'Ihickucnl
h ptll Uinulcicr or W[Ig110 1. Nlnlclial numbers nlld CU111111011 100 llalllcl.
n1/f DES
llom�fa_-_
I'm it --
I'lom_ fn FI. ---- V4 jL1 -
13. 0ROUF: Vepth Mnitli t Method
Ilont h_ L�SSS/C�-
Mom 3_ Iu_ ��_I'LA -P, - e -
14. SCILI?L•N: hrptlt Uta,ucicr ':Ind Si7c N7alcunl
Io—
in.
'lool -----_
15. SANIVORAWL PACK: F '
hrpth 5;7c NLllclial i / -
I�n•m_
---------------
sSy
lilt IIPI!flll'('I'R 1IPY 111A1"I1111 VYTH,WAS t'IIfIS I RUGl lid) It ACCOILOAIICII W1111 15A IICAC 2C.WII.1.1.
CONS I RUCI ION S I'ANUARUS,AND 1IIAT A COPY OF1111S RECUILU HAS IIEE14 PROVIDED-10.111L WELL OviNLR
swrini uue Gf rrllsurl c:u1Js uwcNN(11 w!vdltl.l, un n.
Solved (hc nI lgle•11 to the Ills idea u1 W!jt•r Ou1111(y,(:rinmdlsntey Secllon, 1636 1)1101 Service Crill(jWff It"IfIg ,Ill 01
1,C' It:,tpl�.,rl�� Pp, Inln)111 t��l,1)V hill �n) ,I•,t�,

1111sLL CONSTRUCTION RECORD B��"ZSB3
1Jot(It C.1AAIII -Drpnllulcnl of Ialviloolnent told Nutvinl Rc9oul/eeq-I)ivisiov of WnICr Qunlity-Ortnnldtantct SCClivn
R'F.LLCl1NT 11A CIO lI IINUIVIDUAL)NAaIF. IPl1o11--/L- I /-. �• �L e--- 'CEIl III iCAl11JNN�y�
IN FI.I,CUNI o,%C-I V It Cnnll'ANV NAM C— / (Ye
�..__—.------------1'IIUIIC N
S I A I E 11 F.1,1,CON9I Ill IC'I ION rFRAI ITN-___-------_--_--ASSOCIA I ED WI)PF,Ilplil N —
(it n • dicnl,Ic if n I llicablc _ .
I. 1VP1.1, LISE (Chrck Applicable I It,t): Itc^idrvlild I-KAtvuicipal/Public U hulusllial U Agticultutnl U
t.innitotitlg U Rcrovcly U Ilc:d l'uwp 11'alrr hljccliou U Ulhcl U If Olhcr,List llsc-
2, WI:I I- I OCA11�00,7? �> / � 'I'opnglnphic/I.mtd selling
IJc•alc5l'lhu'm1%l�C __—__._('ounly CL�cr�-'GG_ Ultidge LlSlupc LlVnllry l_II"Int
-_II�Qf'Qr IeAC.4/ Le-.___. .
(Fbrrl tln nq IJund�rn Cnnnnnnilt Snl Jirisirn,L I Iln„iip C,dc) 1,11(IIUd C/I(III�II I1l1C Of IVCII InC/ilnll
N3S`0>�Irf�` WD�3°53 "33.7
/may ----------- ----
1. O1CNI°.it: �VP�//(it Vl/B✓ (grprerdminvlydew.nrl.)
L:Ilituddlvnyiludcsvurcc:Ll(iPSUfvpo(;Inpincmap
12�L'171 U_ItlLl.11i(J I,Qu
('ily rr trn„ SIM, 71e cr„Ir Fulm 'fo Fouualivn llcSCtiptiuu
Arrn nvin I'In.nr nnmher _D � _— ` '` "—
.i. OAIIiORII,I IoO_•f�-/� "L,f� __ /oo- 31—L
5. -1(1I-ALOPPf11 -3 2o2-- -- — - — ---- - —
K. OO \\rS 'I'.I.I, ItEI'IA('It I°.XI.,111uI NVIA 13 YES L.1 NO W1 —
7. S I AI IC NVA I FR I.EVIA, llclv,v'I'up of(':IGiug . -G U.- .._(rh• — _ _-- ---
Ir AI... IIgr ul l'nrinpl ."�
S. 'I ��
I,P Or CASINIJ IS -/�� I"I Above I.nild FIIIII1rC*
------._- Fla--t>
•'l rp rl rndny In ndnnlrJ nlLa LrL.v lord anlnre,nplLn• --- ,�- �—
,nlln,re In %rm,dame will, ISA NCAC IC 1111 N. — s
v. }'II°I.N(I!pn,) ___5� n1111110D Uri FF F/Y. -- ut .w
IU. WATER ZONES (depth): 3�0------------- -- ---
�TH Allln111d_�(Gi SIIow diteclioll mid distallCC 11i IIIIIC9 IIOIII al 1(iSl
11. C SIING: llU1J:'I'ypc� Iwo Sale Roads or Counly Roads. Include the land
IZ. CASING: 1Vnll lhicknc.^s
Ikpltl Dinulcict of Wcig111111 t`Intcli:d 1111111hCr9 mid Wtlllllorl road Ilalllc9.
u�
I'lom
13. 171101)1': I)rplll fInlrlial M1lclbull
I'lvm U ro
14. SC RI:LLI: Orpth Uimucicr dlol Sim 1•In�nl
i
I'ton�_ fo
I'loul------- io
15. SANPIGRAVEI.PAM:
i
Or1,11, SirC Rlnlcl inl - _ =
1711,111 10 171'----- -------
Fivin
1(,. I(HAARI:S: —_------ -
1 OO 1II Cr11Y CIT fit:)'"I I IAT I HIS WITI,WAS('O1131 HKA EN IN ACCOItUAIJCI?WI I It 15A IJCAC 2C,NVRI.1,
CONS I Rt1C1 ION S I ANDARDS,AFID'I I IA1'A COPY 0171111S RECORD IIAS BEEN I'ROVIDED'f0'I IIL1 1VL'LL QWI II:R
-- SIOtJAIIIIII!Or IT,It MIN CONS 1RLICI1N0'IIR!WI11.i. DA'1E
S lilt mit the vl ti;hrll lu the I(II islan (1111'a(rr Qusiily,GI ovuldlynlel'Sec(lou, 1636 61111I service(:enlcr.Ilnlrljlh, rw
( ^ lr:,' I IL•n 1'r l"I"1 '11 1211, 1111Illo 111 '1"N1 (iW-I REV. 1111201111

1 n"
IJo116 Calolitin - Drpa Ill oclit of Irnvirluuucol nod 14111ulal Rcsoulces-Division of Witter llunlily- Uoundwater Sccl it)It
" � " ' Ir ' `C F.IIIIrII,;A"11ON��'7VY
IN 11,CON-I RAC I Olt(INIIIVII)VAL)NAM F, II•t lull )OA&I/S,V'-1S
IN F1.1,CItN I IIACI llll CUntl'AN 1'N.\nllc ASSIICIA"I FII wQ I'F.INIII n
SITIF.wF.I,I,CONSInUCI H1N 1'F,IUII tN---_- ----- If nil rliciblc
1, 1l'1:11,USE (l'I,rck Applicable Ilya): I(csidrnli"I Ill�i`hlnicipal/Public LI Gltlusbinl I1 Aglialhmal Ll
Moniloling u Recovcly LI I ie:d Polop 1Vnlrr hljtxliun IJ Ulhcl Ll If Ulbcr,List Usc_
2. WRI.LI0CA11011: Topop-sphic/I.nndsclliul;
Ncalcsl"fuwn}�y(C.�2h ('ouoly :1_QA[nI`f Q L1Ridgc ILISfigle LIVnI1ry ul Int
-�----- (nc�rk nl•ptnprint.An<)
of well loci l�y
(Sbrrl Nnn,q IJund�rn,Cnmm�mily$nl•Ji rision•I al Iln.,lip l'rvle) Z��f , •' —
✓^�-f-W
' (drprcrn/minulnhrcnnJ.) _
1. 0XV14FR:__I1_ --S_z L (� , �.�------ Lnliludc/Iungiludesuurcc:LIUPS❑1'opoglap6iculap
ndlhCSS 7.L_= 11c-r1L.1 _ L__—_— (check Me)
f r..l:rrl lit lln�ne Nn.) UIULLI[J(l'._LUi;
G _ 1?t,L171
�y, G —d ip(': Ir "-- --- Ilutn 'fo 1°olulnliouUc.^,cripliuu
City orlon„ SIMI, 0 10
r
Nrn ndr 1'hrna nnmbct —
,t. DA11; DItil,I1?ULI -f1S
G. DhL•S 1�'I?LI,Itl?I'I,AI'Ir I'.JiISIIIJU Wp1.1,7 YI?S LI NU U —
7. SIAIICWA1liltLINFLBelow'[oil ofOlsiugt _-_S_G._ —pI'.
Mnnr'I,y of 1'nnioPl
1"f. Above Lund Sol R. l III, kit: CASING IS-__�______ -
•1q,rl rrdnp Ire nJnnlyd Alb",6rinn Irnd nn lore Irgnl,n• —
,er❑ntr In nrtnnlu¢e nith 15A rWAC IC III In.
o, SIIN.II (PPIII): -_)_S —hlI;II IUD UFIFSI_J/}tQ-----.— _W. WATER ZONES (dcpul): ----- LQCnt!_U� K4=L(:
)��-1�no.11 �-C nulouur_ Slww dilection slid distance in wiles I'ionl nl lens
If. UISIIJfI.I:IlU1J:'I)1'c �� (woSlalclloadsorCoanlyRuads. lncludclhctond
IZ. GIBING: Wall lllirknrss
Ilrhlh Dim:ldcr or WeighV16 Mntclial nuulbels slld common road mules.
Ilom—�_ fo phi PL__(P�u25- SV�L31 P��— L"P�nf
I'n•nl 'fo 1'1. --- 1 1 1'eGC)If( e2
1---1 chvrC)�
e
hlntelial Method
I1, UIlhU1'; LrpUl �il+ gi,./eN
I'loul._0 '1", ')&I 1'I._LI� t1,__- - -C�-S-SisC�- 13orhef
I'lonl—_'fo_ _rl.--------- ---- ��
14. SCREEN: Drplll Dinulcicr Slot Sim Malclinl
I'lonl------ ho------fl. iu' ----- in. — r--
15. SANIIlUILANTI,PACK: j
Site hbJClint
Itrptll
•
hU III'Itf ltl' CI:P,TIfI'111A'I"1IIIS Vrf1,1,1VnS('UIJSI Illl(,"II'.0 IN ACCOItDAfICI?Wllll 15A 14CAC 2(' Vsll I -' -'
CONS I RUCI IUN STANDARDS,AND MAT A Cl)PY 01: I I1S RECURD HAS BEEN PROVIDED 10111E 1VPi.L EYV I ILR
__- _--J.. ''--'--- - -- _...-- --------- r _
C I IJJ AJ IIItpO VN III CONS I KUCflNO'IIII;WELL RAIL -
Sultlnil the illIl;lnnl It, file III islnn Ill Willri Ouglily,/auuudrrnlcr Section, 16J6 MnllScrclec C(,`Vr1 Rliv. 9/1211111
r t.•,^ I(Ir 1'6..or No I"!n1711 3•!I,❑Ilhbl all +^1<.

Ire ✓ IJ II711 R ri ll ll
WELL CONS RU1,'I'ION IUXOltl) 1 Et
IJolth CaIo ina - Drpaltnlcnl of 1?11virinonei l and lJnlmaI Itemuces-Divisian of Wntel Q'Inlity-(Jloundantct Scclion
,YE LL QIN7IIACI UII(INIII VIUIIALI N,(MF Ip.Inp_ [;IY}'raS .—�_yn.lil�r7 C] 'CF[t I IrlCA-II(JNH_-
11F1.I.CON I RACI Oft -----
SI-AIF,(\EL1,C1rNS1I1oC1111N I'EIUIITH______.__-___.-----AR51/CIA"1 F.Il NIJ PF.IfP117N — —
i(n
I. \\'pia, USt: (Chr(-k Applicohic Ihrx): Rcsidrulial Iji—N,III licipnl/irulrlic U hulanhinl I I Apliudlural U
hlvoilal ing U Rcrovcly U I Ic:d 1'ungl W:det hycclian U Olhct Ulf Olhcr,List IJsc__—_ _--
2, W H I, I OCA I�R1M I* 1lgmgrnphil/I and .cllaul' .
PCIIcsl'Im%II* trt�S ti_( _S__—_._( ounly Cr1lQ�O IidlCJdge LlSlopc LIVn11cy`,
of vvilil
Lnlinlddlon�ihidc of wrllJu�e/nglil�r�14
(Vrtrl lmnr,Nond rn,l'onunnni�, Snl•Jirisnm I.1 Ila.,lip('ivlr) _ �(D �� -f ��3-- t�-.
` � ♦! (drg.<rJtninnV,yrrnnd,)
1. 0WI4FR:._1-iititi_.5_y .i_�h--��-- --- ------- I_alitudt/Iougiludesowcc:U(il'SUfullnflnp6icmap
._--_I11L'� -- ---- (tl,rrkti,.1
�.^.lirrl o.n�,mt No.) U.i(ILh1171i.-LUJi
— ❑mr Zipco,lr tram 'I'o ponnalion IJcsclipliun
lily o, loan Q
Nrn r,dr- 1'Lnttr mm�be —19 1��--
•1. DAIFORII,IP.Ik'5=10_= 17W 7Sf_;'__ 5..��5•--ll�-'-`k--
5, Ill(At. DI.1'II I:_ 750_______-----_ — — i—
(. DOI:S \VISL1, 111:11IMT I°.SISIIIJIJ \V1;1.1.7 1'RS L I IJO 1A-- --- —
7_ S I A I IC \VA I FK LI'sV6L 1117101v Tap of l'naing: _- ---- -._--t`I" --�-- --
(ll.r"✓•If Aln.vt I..pol 1'"-'Al —
A. 11,1. OI" CASIIJI J IS--__,_(__ 1-1. Ahavc I.nml SIr1111CC* _
•l rp rf rrdnp lr.niL.nlnl nlha bd,n WA an lnrr.rgnh rr• -- �.--- _—
,r.lrntr In rran Jnrtr nIIL ISA NI'Af'lo IMP, ' .«`
9. Y11'.I.D (ppnr): (p ._—Nil:II10D(1RtlSr_ili _C,
10. WA"Il?R LSLCALI(11�SKI!-I i -- ,s?�1—
s�Anunnd_ Sho(v diteclion sad distance in miles onl nl Al
If. DISIIJI'P.0 HOW,l ype (r' Ilvn Stile Roads or County I(oads. elude the Ion "UI
12. CAS11J1i: 1Vnll'lhickncns
Dcpill Dinmelcr or WcigliUl 1, hlnlcliod nultd eta and common told mule
1'lom O Til ISS, 1-1._(�1 _ ' La.L- -�-([.C---- �.
1'nml To
13. 0ItUIJF: Drptll hbl,llrli�l hlclhud
Flom_ 1j._'fo�U'
----
IA. SCRI?I'tl: Drpih IJinmcicr Slol Sim hlPlclinl r
wb:rPer
Ila°r----- 1�°-_...--- I'I. io' --- in. --- o� ��'S9g1+ Rd
15- SAIJD/G.RAWL VACR: r
hrptl, Silo 1.111(eial 6
�� ,44le oar
I'l mil—
I(;.
D() I II'Cf1il•(TR 1II'1"I IIAI"I IIIS WPLI-WAS('Of IS KIRAFD Ill ACCORDANCE W1111 15A I1CAC 217,WEI.1,
CONS I RUC Hill S IANDARDS,AIJD'I HAF A COPY OR'I I[IS RECORD HAS 9EE11 PROVIDEDTO'IIIL1 WELL 01"IIER
1
SIOIIAllilMO17PI(IISON CONS WWI IWVIH8WL'1,1, DA'II.
Submit the Ill Il;lu d to the 1111 idol Ill 1Valrt 01ollily,(:rinindlynler Section, 1636 QInll Service Cenlcr-Itnh Iph,r4(
-._. .... .... - ... ... ,n ......- (AV-1 REV. ill/).()(,
,

WELL C0NIq'1UC 1QN RL'I llu�tll
iJollh C:v ulina - L)rpallnlclll of I!nvi l ournc[It and 14111 tit al IleC.nowccs-Division of Wnlunlily lcr i -Uruuodwalcr Scctiun
IVFI,LCt)NIIIAClt11l(INI)lV-11)IIAL)NAPIC trh,l)-_ C ecc of 'Cf.Il11f P_AIIUN M_�y�'�
IV mi.cUN I nACllltt COAll•Al NAN117 � /•(ler_-----------------------1•IIUNr n
SI-AIF.IIF.LLCIrNS1Il11C11UN 1'F:IUIIIX_________-------ASSOCIAItq)Ivl)PEIUII IX ----
it❑ • lit it'llr) if n t licaldc
Il l: Applicnhlc IIua) IGr.^.idruiinl♦ phmicipalll'nhlic U Imiushinl Cl Aglicultulal fl
f.louilm ing CI Ilccul'cIy Cl I lead 1'ungr Nv:llrr Injeclioll U other U If ilhcr, Ust
2, WH 1, 1 OCAI 1011: / 'fupvglnphic/l.nnd selling
('aunt) [ r'a(LeC ❑Ridge LlSlupc 1=lVnlley LlPlal
IJcalccl'�uten:—�'� �f")� _[//r
LL (rhttt nppvgr,inre hm)
7074i/411
(Sberl Nvnr•Nand•e,,,l r nununitp,Sul hnsiou,I 1 It,,,.7ip 0,1r)
Lnliludc/longilude of well lucntiun�r
ArAdl plepreen/minm.dcrr"naly
I,nlitudcllvngitudc sum cc:U(iP$1 J fopvglaphic map
Addlcss12. �.k(5 -0.-. __—_----- (chrckIl
`urel n[Rowe Nu.) (I LI,IIJU._I,U l' Ii lI�I_U1 UI.
Fivm 'I'u fvnuatioulDCrclipliuu
Ci1p or lawn $mIr Zip Cade —
Nrn rrvl.- 1'Inme mm�bel � --
5. I III-A1, III Ir I II —_--
6. IIUfS 1VIiL1, Itf.I'I.ACI11'.AIS11N11 W1:1.1,1 yi;.S U IJU l — ---
/. S I A I IC WA I Flit LEVEL 11clow'lup of
it••V'I r At.... 1 np of 1'n•inp l
R. Il ll Uf CASIIJI; IS--_��-_-__._ I.-F. Almve I.nnd Sullirce' Q
•1 r•p nl[nI"p Irrrnlnnlrrl nlP.r Irrinn brad e,n lore IrquL r,• -•G r'+
.nrlrncr In rrrtm donee"lilt 15A NCAC 1C,111I X. N
o. 1'IL'I.11 ^a
Ill. NVAI Fit ZU1JIi.SIdcpllq � —_--- LQCAAIUIJ YI_I_C)l Ln
__ �i Show dilecliun nud distance in miles Plum tit Ic
I. I11S11J1"f.0 1 IUII:Typc_/� T� Aul""ul-_Y�--- Iwo Stile Roads or Cuunly Ituadv. Include the Ioad
12. CASIIAl Will'Ihickncss
D'pIII Llimncicr or Weight/Ft, pinle i:d 11111IIhef9 nlld C11111111U11 road nnmc9,
Ilam� fv z 1._
1t, UI(hlll: VC1,11r /jlnl/rJi l
h clhod� 4 )i
1-0. Sl'REL•tJ: hrplh IJimnclrr :;lotSirc ttalainl
15. SANU/I;RAVIA, I'Al
I1rptl, fire 1,1111clinl
1 DU 1119'.I'Itti'CliRlli'ti'I I IA f 11115 V+1 1.1,1VA;Cl1fISIlI11C1lib Ill ACCORDANCE NVII H 15A IICAC 21 tvlil.1,
CUPS i l(UCI I"Il S I"ANDARDS,MIDI HA I'A C(. VY Of,l Ill IIEC0I1l HAS BEEN FRUVIDEU'IU 1 I IL' SVL'LL UWI If I!
y'•-l/OJ�
, lx ——
--- -- ---- M;I IAI()[III(IF I'1 ill CONS 1 RUCI IlIll!WILL DA"I V
Sulnuit Ills uIll;lu tl In file bit i11nn ul)Paler (lnelily,(;Iu(unhvnlcl Sell[oil, 1636 pinll Service Cf'1Vrl I!1!VLI t,rlol l

WELL CONSTRUCTION RECORD 0'-'W 311828
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) James B. Brown CERTIFICATION#2045
WELL CONTRACTOR COMPANY NAME Hedden Brothers Well Drilling, Inc PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 171 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATI Topographic/Land setting
Nearer�T,o�,w,en^: p�� County ❑Ridge ❑Slope ❑Valley ❑Flat
l�f'(. z"L (check appropriate box)
(Street Name,Nu ers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: (degrees/minutes/wconds)
Address A, cdzu Latitude/longitude source:❑GPS❑Topographic map
( treet or Route No (check box)
)AAA � ,.R9` DEPTH DRILLING LOG
iry or Town Ste Zip Code From o 1 Formation Description
r ?0 Clay it Sand
Area code-Phone number ' Granite
4. DATE DRILLED
5. TOTAL DEPTH: t,�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO J c
7. STATIC WATER LEVEL Below Top of Casing: 5() T.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS zi FT.Above Land Surface*
"Top of casing terminated at/or below land surface requires a
variance in accordant with 15A NCAC 2C.0118. _
9. YIELD(gpm): 4 METHOD OF TEST BLOW
10. WATER ZONES(depth): 1Q,W' I jOg' i Z LOCATION SKETCH o
11. DISINFECTION:Type H T H Amount 160, Show direction and distance in miles from at least ;.-
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To Ft VC
From h To FL
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.Benonite&Cement pumped
I
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDA7S,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATU F PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management, 1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

10i
WELL CONSTRUCTION RECORD 3 4
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVID F. MCKINNON CERTIFICATION#2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP CO„INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT# _
(if applicable) (if applicable)
C
1. WELL USE(Check Applicable Box):Residential X MunicipaliPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: ML41 p1-i County CHEROKEE ❑Ridge ❑Slope ❑Valley ❑Flat
TARHEEL NORTH TO LAKEVIEW @ TARHEEL (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: TODD MOERCHEN (degrees/minutes/seconds)
Address 728 SEA GATE Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
7 4M pta I FL 33602 DEPTH DRILLING LOG
Ct Town State Zip Code From TO Formation Description
7( 27 )-638-9744 0'TO 20' RED CLAY
Area code.Phone number 20'TO40' BROWN SANDSTONE
4. DATE DRILLED 04/18/2005 40'TO 60' GRANITE
5. TOTAL DEPTH: 805' 60'TO 805' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑ 24
7. STATIC WATER LEVEL Below Top of Casing: FT.
(Use"+"if Above Top of Casing) A �'
S. TOP OF CASING IS 1 FT. Above Land Surface* cs
`Top of casing terminated at/or below land surface requires a — t�—
variance in accordance with 15A NCAC 2C.0118. N
9. YIELD(gpm): 0 METHOD OF TEST AIR
10. WATER ZONES(depth): US
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at len
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 60 Ft. 6 1/8' SDR 21 Pvc
From To Ft.
From To Ft.
13. GROUT: Depth Material Method 4i
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. �P
16. REMARKS:WELL WAS HYDROFRACTURED-YIELD=6 GPM
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD/yHyA�S BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 310752
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVID F. MCKINNON CERTIFICATION 2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP CO„INC. PHONE # [phone]
STATE WELL CONSTRUCTION PE,RMrr# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) _
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Infection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting'!
NcarcstTown: MukDKY County CHEROKEE ❑Ridge Slope ❑Valley gFlat
TARHEEL NORTH TO LAKEVIEW 0 TARHEEL (ch ck appropriate box) ',
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: TODD MOERCHEN (degrees/minutes/seconds)
Address 728 SEA GATE Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
74M 4 FL 33602 DEPTH DRILLING LOG
City or To state zip code From To Formation Description
7( 27 )-638-9744 O'TO 10' RED CLAY
Area code-Phone number 10'TO 20' GRANITE
4. DATE DRILLED 04/20/2005 20'TO 805' GRANITE
5. TOTAL DEPTH: 805'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO -LT
7. STATIC WATER LEVEL Below Top of Casing: FT. D
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface* fV _
-Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.0118. Ln
9. YIELD(gpm): 0 METHOD OF TEST AIR
10. WATER ZONES(depth): 11 S i L e
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and co road names.
From 0 To 20 Ft. 6 118" SDR 21 PVC X
From To Ft.
Fmm To FL_ —
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY �b /\
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 FL
16. REMARKS:WELL WAS HYDROFRACTURED-YIELD=6 GPM
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONS�CTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 1
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print). WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP CO„INC. PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water nj ction❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge Slope ❑Valley ❑Fiat
INDIAN ROCK SPRINGS TO SAKANAGA DR check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: RANDY DOCKERY (degrees/minutes/seconds)
Address 5510 HWY 64 WEST Latitude/longitude source:❑GPS❑Topograpllic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8828�- 361-1998 0'TO 20' BROWN SANDSTONE
Area code-Phone number 20'TO 40' RED SANDSTONE
4. DATE DRILLED 04/21/2005 40'TO 100' SOFT SLATE
5. TOTAL DEPTH: 705' 1 00'TO 141' BLUE SLATE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO _K 141'TO 705' SLATE
7. STATIC WATER LEVEL Below Top of Casing: 150 FT.
(Use"+"if Above Top of Casing) wJ
8. TOP OF CASING IS 1 FT. Above Land Surface*
-Top of casing terminated at/or below land surface requires a t
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 1 METHOD OF TEST AIR
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at leaf
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 141 Ft. 61/8' SDR 21 PVC -
From To Ft.
From To Ft. (�
13. GROUT: Depth Material Method // Y
From 0 To 20 FL CEMENT GRAVITY A)
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material 1 S�
Fmm To Ft. in. in.
Lo
From To Ft. in, in, yQ
15. SAND/GRAVEL PACK: v
Depth Size Material J�
From To Ft.
From To Ft. f{w cJ ES 7-
16. REMARKS:YIELD=1 GALLLON EVERY 50 SECONDS
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 BE PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRU ING 17HE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004

WELL CONSTRUCTION RECORD 1
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prinQ DAVID F. MCKINNON CERTIFICATION#2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PtIONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) I (if applicable)
1. WELL USE(Check Applicable Box):Residential)( Municipal/Pubfic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water n)ectlon❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE Ridge ❑Slope ❑Valley,_ ❑Flat
TARHEEL WEST-277 WEST RIDGE DR (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: IRVING RUFF (degrees/minutes/seconds)-
Address 277 WEST RIDGE DR Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28 )-361-0396 0'TO 10' FILL DIRT
Area code-Phone number 10'TO35' BROWN SANDSTONE
4. DATE DRILLED 04-26-2005 35'TO 40' BOULDER
5. TOTAL DEPTH: 805' 40'TO 60' BROWN SANDSTON
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 60'TO 80' GRANITE n
7. STATIC WATER LEVEL Below Top of Casing: 650 80'TO 805' GRANITE r
(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 requirra a f V
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 1/6 METHOD OF TEST AIR
10. WATER ZONES(depth): BIT SIZE 6.029 u1 r
LOCATION SKETCH
It. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two Slate Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 80 Ft. 61/8" SDR 21 PVC
From To Ft. 7;fk"CeL k2QS7-
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From TO Ft. in. in. d
From To Ft. in, in. 70
15. SAND/GRAVEL PACK:
Depth Size Material (J cp�7-
From To Ft. V
From To F[.
�77
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON OST JUCCTAIG THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
10595
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (Print) WILLIAM BRADLEY LEWIS CERTIFICATIONN3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. plIONE N [phone]
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMITN _
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water njection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo raphic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge Slope ❑Valley []Flat
CLARK BRANCH RD (check appropriate box) ' -
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of wen location
3. OWNER: MARVIN RAPER (degrees/minutes/seconds) --
Address 1241 HWY 64 WEST Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To FonnationDescription
8( 28 )-835-7334 0'TO 20' RED CLAY
Area code-Phone number 20'TO 60' BROWN SANDSTONE
4. DATE DRILLED 04-07-2005 60'TO 80' BLUE SLATE
5. TOTAL DEPTH: 305' 80'TO 305' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO JX
7. STATIC WATER LEVEL Below Top of Casing: 100 FT. p
(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 �N
variance In accordance with 15A NCAC 2C.0118. T
9. YIELD(gpm): 6 METHOD OF TEST AIR
10. WATER ZONES(depth): LOCATION SKETCH Ln
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at leas
12. CASING: Wall Thickness two Stale Roads or County Roads.Include the to"
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 80 Ft. 6 t/8- SDR 21 PVC
From To Ft.
From To Ft. Q
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diarrreter Slot Size Material Q 4
From To Ft. in. in.
From To FL in. in.
15. SAND/GRAVEL PACK: e
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THA �COPYOFTI7115REC HAS BE PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUC PIG THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 3105 ,94
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
mill
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial❑ Agricultural❑
Monitoring El Recovery ❑ Heat Pump Watertection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topof raphic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge Slope []Valley DFlat
PEACHTREE-271 YONCE RD (((check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location s
3. OWNER: DEWAYNEPLEMMONS (degrees/minutes/seconds) _ -
Address 271 YONCE RD Lautude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip code From To Formation Description
837-9240 0'TO 20' RED CLAY
Area code-Phone number 20'TO80' BROWN SANDSTONE
4. DATE DRILLED 04/06/2005 80'TO 100' BLUE SLATE
5. TOTAL DEPTH: 245' 100'TO 245' SLATE 41
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO JX
7. STATIC WATER LEVEL Below Top of Casing: 50 F F
(Use"+"if Above Top of Casing) ya
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated at/or below land surface requires a tV
variance to accordance with ISA NCAC 2C.0118. �:tv
9. YIELD(gpm): 50 METHOD OF TEST AIR
10. WATER ZONES(depth): 160' o
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common mad names.
From 0 To 100 Ft. 61/8- SDR 21 PVC
From To FL
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT GRAVITY
From To Ft. Y\
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TIWA
�COPY OF THIS RECORD HAS BEE 1 ROVIDED TO THE WELLOWNER
SIGNATURE OF PERSON CONSTRUCr THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 310593
North Carolina Department of Environment and Natural Resources-Division of water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC PHONE [phone]
STATE WELL CONSTRUCrION PERMIT# ASSOCIATED WQ PERMIT#
1111000011 (if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential MunicipaMblic❑ Industrial❑ Agricultural❑
❑Monitoring Recovery ❑ Heat Pump Water njection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: wZPH County CHEROKEE ❑Ridge ❑Slope 0 Valley [Plat
NEAR ENTRANCE(2ND W LL ON ORTON EASEMENT) (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: THE SANCTUARY AT VANCE MOUNTAIN (degrees/minutes/seconds)
Address 4750 ANDERSON RD Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
�LA1Q5Vt6L.e GA 30512 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
(72)-835-6300 0'TO 20' RED DIRT
Area code-Phone number 20'TO 40'
4. DATE DRILLED 03-30-2005 GRANITE
5. TOTAL DEPTH: 205' 407 TO 205" GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 62 y,
(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 accordancenith 15A NCAC 2C.0118.
9. YIELD(gpm): 22 METHOD OF TEST AIR
10. WATER ZONES(depth): 140'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 54 Ft. 6 1l4" .188 caw.SrL
From TO Ft.
From To Ft. Qp
13. GROUT: Depth Material Method l\
From 0 To 54 FL CEMENT GRAVITY
From To Ft. �' 0
14. SCREEN: Depth Diameter Slot Size Material
From TO Ft. in, in. t� a
From To Ft._-n. is
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. IrvX,l/
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A C Y OF THIS CWG
PROVIDED TO THE WELL OWNER
-
SIGNA OF PERSON CONSTRLL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.0912004

WELL CONSTRUCTION RECORD 310592
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) DAVID F.MCKINNON CERTIFICATION#12411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # (028)837-BOOB
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water nlection❑ Other❑ If Other,List Use
2. WELL LOCATION: TopogrdphicILand settin
Nearest Town: MURPHY County CHEROKEE ❑Ridge ❑Slope ❑Valley Flat '.
JOHNSONVILLE RD TO ROLLING HILLS BETWEEN LOT 14&15 (check appropriate box) r `
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: MIKE GUTHRIE&SKIP HUSKINS (degrees/minutes/seconds)
Address P.O.BOX 295 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8< 28 )_360-5550 U TO 20' RED CLAY
Area code-Phone number 20'TO 80' BROWN SANDSTONE
4. DATE DRILLED 04-12-2005 80'TO 100' GRANITE
5. TOTAL DEPTH: 605' 100'TO 605' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO a
7. STATIC WATER LEVEL Below Top of Casing: 150 2
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS i FT. Above Land Surface's °�—
•Top of casing terminated at/or below land surface requires a O
variance in accordance with ISA NCAC 2C.0118. -- --'
9. YIELD(gpm): 12 METHOD OF TEST AIR Z
10. WATER ZONES(depth): 300',580' BIT SIZE 6.003 t3
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 100 Ft. 6+M- 486 '
From To Ft. (P�rk S�_2) )vvs K
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. rlSdrr lye o^ rv\
From To - Ft. iL in, o V u+
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A=RECORD HAS BEEN PR9 DED TO THE WELL OWNER
SIGNATURE CIF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 310591
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (Priat) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # ( )837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) -
1. WELL USE(Check Applicable Box):Residential) Municipal/Public❑ Industrial❑ Agricultural 13Monitoring❑ Recovery ❑ Heat Pump Wate nlection❑ Other❑ if Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: /hu2Pj�jl —County CHEROKEE ❑Ridge Alopic ❑Valley ❑Flat'
BEAVERDAM RD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: BILLY R.COLEMAN (degees/minutes/seconds) „.._._.
Address 1402 19TH ST Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
p/ Nd `6oQ FL 34683 DEPTH DRILLING LOG
City or Town State Zip
From To Formation Description
7 7 -789-1756 0'TO 20' RED CLAY
Area code-Phone number 20'TO 60' BROWN SANDSTONE
4. DATE DRILLED 04-12-2005 60'TO 80' BLUE SLATE
5. TOTAL DEPTH: 305' 80'TO 305' SLATE =`
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 9-
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use"+"if Above Top of Casing) "t
8. TOP OF CASING IS 1 FT. Above Land Surface* x
`Top of casing terminated attor below land surface requires a N_
variance In accordance with 15A NCAC 2C.0115.
9. YIELD(gpm): 13 METHOD OF TEST AIR {=
10.WATER ZONES (depth): LOCATION SKETCH
Show direction and distance in miles from at least
1
12. DISINFECTION:Type CHLORINE Amount. CASING: Wall Thic 1 nesess PPM two State Roads or County Roads. Include the road
k
Depth Diameter or WeighUFt. Material numbers and common road names.
From 0 To 80 Ft. 6 118" SDR 21 PVC
From To Ft.
From To Ft. X
13. GROUTDepth Material Method
From 0 To 20 Ft.CEMENT GRAVITY
From To FL Q) D
14. SCREEN: Depth Diameter Slot Size Material J/
From To Ft. in. in.
From TO Ft. in. is
15. SAND/GRAVEL PACK:
Depot Size Material
From TO FL w�
From To FL
Rb
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT OF Tins RECORD HAS BE PROVIDED TO THE WELL OWNER
AY2.Q- V-.20 -O S
SIGNATURE OF PERSON CONSTRUpMarTHE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 3 1 O 5 A
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION 83368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE N [phone]
STATE WELL CONSTRUCTION PERMIT0 ASSOCIATED WQ PERMITB _
r.
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):ResidentialA Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
i
2. WELL LOCATION: Topographic/Land setting '
Nearest Town: MURPHY County CHEROKEE Ridge ❑Slope ❑Valley ❑Fiat
CULBERSON(CEDAR VALLEY FARM) (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location "
3. OWNER: ED MANN (degrees/minutes/seconds) _
Address CEDAR VALLEY FARM La6tude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
8( 28 )-835-3147 0'TO 20' RED DIRT
Area code-Phone number 20'TO 40' BROWN SANDSTONE
4. DATE DRILLED 04/12/2005 40'TO 60' SOFT SLATE
5. TOTAL DEPTH: 285' 60'TO 80' BLUE SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO JN 80'TO 285' SLATE g>
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS I FT.Above Land Surface"
—
•Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 100 METHOD OF TEST AIR T
10. WATER ZONES(depth): 140'-6 GPM
280' LOCATION SKETCH cJl
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two Stale Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road tames.
From 0 To 80 Ft. 6 1/8' SDR 21 PVC r
From To Ft. /
From To Ft. S µr C
13. GROUT: Depth Material Method T 1,
From 0 To 20 Ft.CEMENT GRAVITY (?
From To Ft. Q�
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. i
15. SAND/GRAVEL PACK:
Depot Size Material !
From TO Ft. [Q/
From To Ft. t
k
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND T AOPY
OF THIS RECORD �S BEEN PRO DED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTIN WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days
GW-1 REV.09/2004

NC V� 0111lI I( )11111
tivEi,u CONSTRUCTION icii;c:uRD
310 '715 `
Not III Catolilla -Depml lnlcltt of laly it uuutcul lnld Natural Itcstnnces-Division of Wntcr Quality-UNInnd RitIct Scction
1vF L CON I nACI Olt(INDIVIDUAL)NAME. (11,1i� d'--5— ���v�— 'CF.it11FICAiIUNhd—y2�1
tv FLL CON I I(ACI Olt CIJMrANY NAME:�� �{ �_�_(1\ I\Ic✓� --- 1'IIUIJP. M Ik.7ti t 37—
SITIF, %I FLI,CONSI ill CI ION rEl1h11711 ._—__ _ASSOC'IAT V.D M)E'FRMI IN
tit n 4iC111+ ifn , rlicablc
I. \\'1•I.I,USE(Chr(k Applicahlc Ilox): ItcsiJrulial I,41hI III,icipal/Public ❑ Industrial El Aglicullutal U J _
Nionil(il iug U Itecovrry Ll I lent 1'mop W:drr, lujecliou U Ulhcr U If Ulhcr,List Usc ' -
I
2. \VITI, I OCA IIUN: fupoErnphic/IanJ selliup
IJcalcsl'IIn)%%\iit, -CulnllYd -CALC�n- Ultidge A.1'.Slupc ldvallry UII.1t
(d,trk nlgngnlnir h•,<)
CAI11 .
(Glrrrl lJnnm,Nm1nbrn,Crnu,omiry,Sul Jnitirn,I,1 It,,..Zip l',dr
) Lat i lude/Iongit tide of well locafion
3, ll\1'IJhlt:-�t _ t'- (drprerJmLnn.drr�,rnd.t
Addlcss �35._.. )NOI'f, R ------ Ln(iwddlollgittidesourcc:U(tpsURrpogl lluicf�latl
+rQ-fLf 2.1'\ ------
role III,.) --•. -
UJI
tuyo, Ir.y(, sinrr ziptr�le ------- hloln 'fu �Poll{lali�m� IJc,cfiplion
Airn c,.lr-rhme nnrrrhrr
5. llfl'Al. PITI If:
__lP-��2 __---_----- -
(i. DOES \Vlfl.l, ILLI'LA(•E F\ISIItJU Wf'I.I:) )'E.S LI Ill) IiJ- _
7. S FA IC\VAIIIR Ll'sVl'sl. Pclow'fup of l'asiug: 7-0
(Ure"e"If Alnrvr'1�qr of t'nrinpl Z7
OI'CASIN(7 IS _ _ U 1'. Abovv I.nIll Suttucc'
•l rp rl trtlnp In mlantrd nll••r Lrinn Innd an Inre Inlah re
r nrtrrrte In ac"ttlu,re«Ilh IRA NCAC IC.III In.
--h1EIIIUDUhTESI-.,,U�_ — e1
IU. \VA I EIt 7,Utl1.iS (depth): -- -
LSLGAlIVIK[-CC71
11. 1)I1;1141 I;C IIUN:Type}p - Aluauut_ \ Show dhectiotl and distance in Miles from tit Icasl
12. CASING:
,Vnll'Ihirkncss Iwo Stale Roads or Coouly Itoads. hlclude the toad
Drplll Uinincler or WcighUht. A1ntclia1 m111111crs and common toad names.
1`loln,—�_'fo 6,)Q , fl._(,,,25 S [-2l Vf /I40/r,'5
O
----
13. (JRUU I': Dcplh Mnlrlial Method
floral- C 'Tu --)Q_
—
14. SCRIT11: Drpth Dianlder SlotSizc hlalclinl {
I'rinn _ To -
15. SANIVURAVIII. PACK!
Depth Sirr I,In(ainl
Flom -lo—_hL----- ---..___.
P1unl To
Ih. REMARKS: --- -
DU 11FRITY CI.'ICllp1'111A F1IIIS\Vhl_I,WAS CONS IRIK-1I?D IN ACCORDANCH Willi 15A NCAC 2C,WITI.
CONS I ICUCI ION S I ANDARDS,AND'11IA f A COPY U1711IIS RECORD I IAS BEEN PROVIDED 10111L' WELL UV:NCR
SI(ilJAll)ItE,Uhl'I?ItSUNCOtJS11tUCI1tJU'f11EW11.1,h DA1L'
Sulnutl Ills of Iglnnl to the Dh islon oI A\'lllrr Qunlily,CIouudlYnler Scctlun, 1636 Milli Service Crn(cr- Pnlvlgll,Nf:
< .• 11111.1....... ri.. 1-11.,+I11,11 <,If6Lr '111 (;W-I REV. U7)"PI01

— — wa,►;L CONS'lulUC ION RLCORD 3107 9_
1JoI Ill I CaIoIiIIn - Drillllnle1:1 of FlIviIU III I let It and tJnlulnl Itcso III ccs-Division of WnteI Quality- (3luuodwnIcr Section
reFl.t,CON nrncl Olt pnun'I OVAL)NnnIF pnh�Il�y�c�ri2,S__Q___1c�-�S.o-✓\
`C FRt I r ICKn ON 1/G
�J_Sall 4c�
It eLL t'oN nL1l-lpn Cunlp,kNY NAnIF I VLI I QS=.—irJ�---C�Ct�.uv —�-.-------
SI-AI Ell'F.LI,CONS 11111CIION I'F.IUllln--.------—_— _ASSOCIAIMM)PEItnllln r _
if n I dicablc - _
1. \MULL USB(Check Applicible llo- ): Itesidrutial I1V'hLmicipal/Public U hufushial❑ Al;licuhmal U 4
Alonitoling U Recovely U I Ic:ll Irunrp WWI Injcclion U ()Iher U If Ulhcr,Lisl IJsc t�
2. \\'1;.1 1, 1 OC A 11011: \/ - Topogrnphic/I.and selling; '
IJcatcsl lotvm ( o1"'I)'.� �.LS_��y-!? Ultidge l ISlupc IN alley Mat
-� C`��`�_._���� _-. frhrck npin nprinl•hn.) �•
(.nrtrl r1n nr.N�nnha ) l adiludc/Iongilude of well lucahrn: u
n,Cnnunnnil Snl hrlsinn,1 117 lip 1l.h) M� I
Lntihuldlollr�c quill�c'c�'.LI(iP51J�1'opogf aphi'•
N 0
. ��1Q (drplern/ndmaa n .nml. -_.
Address ��L�.Gree (eheckMre)
(slrra nI It`nlle IIv.) UIULI,II ItJ_LUt
1>�I_Ul
Z .._.------'— Flom ToI'olulalion IJcxcriptiou
n
Pity or loa Srn1e lip('ode
Nrn n�lr-1'hmm mnnberl 1 —
4. 0A 11: Dit 11.1 1:1) -
i—
G. IH)IiS 1\'FI-1, ILI'.I'LAl'I'. I?\ISJJIJIi \VI'1.1;7 YIiS I. -
7. S I A IIC WA I IA LBVIiI, llcluty"I'op of('nsiugt --
(U-e-I••If Alurvr'I np nr 1'n•ingI Pa
A. ll)I' UI" l'ASING IS__"1__-_ _ 1-1. Above Land Sul lace'
r'I rI�nl ndnp Ire oJnnlyd ni/n'hrinn Innd nnlnre Irq nh en• 03
rnl loon In nr cnnlu¢t nhh 15A NCAC V7 III IN. FP
o. Y 11:11)Q1,111): 3-- nu:fuuD UI• IFS3�--
IU. \VA ILit zUNL•S (depth): ------- LQCn"j)_Qj+5K►J-(; �
Anurunl S Show dileclion and distance in miles lion)Ill lead
If. DISMI-TU 1 IUN:T)pe Iwo Stile Roads or County Roads. Include the toad
12. CASING: Wall 1likkness
Ilepth Dinwcicr or Wcig111/14 hlnlctial IIIIIIIbcrs and commun road umncs.
FIoln I tr_ 171 —.-- -----
11. (JIIUUI': ❑rpllt Male ial `' hlclhod /�ru e
Flolrt_[)__-_ ftr
Flom_--'In
14. SCREL•N: llepth Dimilder Slot Sim Matelinl
---
I'lom___
15. SAM)IGRAVFI.PACK: 4,f��3
I)rp(it Sire hhde(in]
I'nmI I --_---_--
16. RIJAARKS: --
1 Ixl I11'lll'l1Y CFIt f IFY'1IIAF 1IIIS WFLI,WAS("Of ISI MCII'.D III ACCURDANCIi WIIII 15A PICAC 2C,WITI.
CONSI RUCI IUtJ S I ANDARDS,A14D'I IIAF A COPY OF'IIU S RECORD HAS I)EGN PROVIDED•101'IM WELL 0\Vt11i11.
— SIGNAIURIIUFf1'.ItSONCUNSIlfUCI1N(II III!WL'LL
Submit Ihr m ll:hrd (It the Ills itlolt 111 Wnlrr 1)u:1111y,Cl uundlvnler Sect[oil, 1636 51nll Service Crnurl Ifnlrlgfl, C

WELL CONS'JuUCTION ► ECOM
IJot lh Cnl III ilm - Drpal Jowl d of Fliviruutneut and Hatutal Resoloccs-Division or writer(Quality-OlounJ\voter SccI it)n
\VF.1.1,CorVIItAC"I UII(INUI\•In IIAL)NARIE gnlnp E.�.-1_� S0.1n 'Crl(IIf ICAl1UNN CCU
ruUtir. n M)S
ASSIICIA7 r.1/R'fJ 1'EIINIYN --
S1-AIF,IVF'1.1,(-ONSIIIUCIIUN tln : Jicnhlc
11
I, 1t'PLI, LISL• (Cllrck Applicnhlc 11WO: Rcsideuli:d ILI--Munir.ipal/1lnblic U loduslliai 17 ngOcullutnl U Mouiloliog U Itecoecty LI Ileat PtIlly 1Valrr lujcclioll U Ulhcl U If(Jlhcr,List Usc ---
2. XNTI.I. I OCA 11014: `` L Topoginphic/I,nnd selling
alccl'fmvn:�i� _ Comity rye--O. e-e 1U)Lidge l_lSlupe LlVnllcy Llflat
` (cheek nrplcaninle bn.)
LntiulJdlongiluJeofWCIIloc-16011
(SLrrl rinuv,7hnnbnr,l'rnunnnil?'.SnbJie ision,tol It,,..lip 0l 10 , „may. IN ��-
.�� (drp,erJminnl.�ercnn•IQ-J-
), OWIJIT:1�Jy 0p1 pn-__ LnliluddlvngiluJe suwcc:Llcif SUfupoP,lnphic to p
Addiccs �s¢.�.__ f[-_q-t �-��_ .._.-__----- (check F
(Stlrrt of Rnole Nu.) u1111.1,11J1i_1.01
�
A� TO6_ It4L'l11
— _tti(_MI - ----'------ prow 'll1 I'otumlioulJcsctipliuu
l-ily ul lnaan Slnle lip Canlr — lot
A,rn c,rlc-rhmm number
4. Ili\l 1: PRILL RU l�S
I --
5. rtlrnl. nr:rrn:_Sys._-___----. _-..
G. Ulll?S 1VIt.1,1, 111:11LA(•11. RXISI IMI WI:I.1.'! YFS LI IJU I]J --
f -
T. $I'A1lC\VAl7i1L LIdV LI. l)clow'I'up of(':,^.in !:_ --F'L
. rg
(U•e'•r•'If Abner I IT of t'nrinp) 91 ,,,•
F. '11)11 01! CASINI IS -. \_.__— 1-1'. Ab(1vc I.nnJ Sullacc' L
•l rp rr odvp Irnnlnnlyd nlhn brinn Irnd nnl•re Inlnlr rr,
.nrl acer In r.ccrldrnce nhh 15A NCAC P-Alt 18. no
�. � 11EL1)1PP1111: _ _—NII:INUU UI. 1151_}��r_
10. RVA I ER l(n1LS 0"11111): ---- 1,QQ1UIO1j-5M_LO11Ln
------ Show diteclion and distance in miles I"uIll Feast
I1. NISIIJI I:.CI1014:1yp nnnluul -.)Et—ch — __ , SlateRo dsor Comity Ronds. loclude fond
12. CASING: 1Vnll'iIdAncss
UCplh Uimncicr or weight/H. hlnlctial uumbcrs and ouunvn ronJ nasne.�rJr
n / Lt
Ilnilr LI 'fo�v-I"1._,(,Q_,y <nv r�l
fF,JJt �s
it. lIIlOUI hrp(It NVdletial ' Mclhud
ftow-�_— fo�Q�I1. '�c •✓\�- ;1 J1�.5�11C� I
Mont—_
14. SCRI:L'N: h'plh Dimncter Slut Sim Malclinl
S�'e
15. SAND/GRAWL PACE: Sire talnklinl
I lcplh
CILI
l all l ll;hl:ul ulA'r'I nIS IVPLI,WAS COIIS11tLICIIJ,U Ill ACCORUAIJCL W1111 15A NCAC 2C.VTI.1,
CON rl_11r1f1 S I IIUCI JON S I ANDARUS,AND 1I IA I A COPY OP•1111S ItLCURU I IAS JILE14 PItOVIULD 1011 W MALL OIYI IIiR
C—
e —
_— SIGNA iltR Uf 1'1'.ItSON CONS111UCHNO'lllll WELLUn'II.
L
Submit the oill.11111 (IV Me Dhislun u111'alrr Oa:dily lauuud\vnler5ecllon, IGJ(p1nl15enlceC(JWrI I!IiIVI'l)//2ggl

unrn rt rrnu -_
NVELL CONSTRUCTION.RECORD
1IO1111 Cnlolina - DrpalUnclll or Envitouulcul and I'alwal Ilcsuulces- Diviisiuu of Willer Quality-U a uundwoler Section
IN ELL CON I ItAC1 Olt(IN 111\'1n[JAI.)NAhI F. ll^1'rll.�_1_�1ti"l.C-'S r 1Q-l� •CF.Itl lrll_'A"I IUNN���
\\eLt,con I uncl uu cf rnu•nnv Nunn:mi�1_�:C_._���—C1 L-1�1�'L°}------
F1n1Ne N 15l¢1-�ag9ir
S I-A I E w FIA,CANS 111"CI ION I' "O'll7 N_____—____— _ASSOCIA7F.11\YI)1'F.IIa11lN
Of n ' rI1l:IIIIr if n r rlicahlc
I. (\•PI I, USE (Check Applicable If( a)! Itesidrnliol Itl---hlunicipal/1'nI)I1c U Iulushial U Agiicullutal U
hfoniloling U I(ecovcly LI I lead Poolp Walrr Injection U Olhrr U If Other,List Use --
2. (VPI-1, 1 OCA 1101-1: 7'upo�rnphi /Lanrl 501ing
N cnlcst'l (blllll)'.C1\P_CU1� ft9 Ultidge CISIopc Icy Uflat
- \ �--- (rhrrk nl•pr nprinl.hrr<)
(.SIrt[1 Nnnv thnnhn•,Crnunnnill,Sulnli rininn,Ipnl Inya,lilt CII,lr) LIIIIludellollgllude Of\Yell Incnlplll
(drplerdminul.darnn.h)
-alitud Jlougihldc sulncc:C1(iPSO fopoglaphic map
Adnccss 1517_-GC=/I141n.Ji _----- (CheckM.)
(r,flrel m Itonle th') I Ili I,UI
City of It.0 lr /}Inlr Till 00r I Off IaI0111)C^l'II 111r111
I'II/Ill /1 ' f I
Arrn rr�lr 19unir manhrr I� t — `� � ��
5.
(i. 1)ll1:.S \\'1111.1, Itl'I'IACR ISMS 11140 Wl:I ;I PISS LI NU 1.1 -g
7. S I'AIIC RIA fliR LIiV ISL Ucluw'fup of l•osn l; _-EIQ._._ __ ------------- —�-- —
(U•r"r"If Ahocr lap of l'n-inpl pa —
R. 'I l\I' l\I' CASI1,41', IS _- 1-1'. Above I.mul Sulhlce' —�--
•7 rp eftrdnp Ire nJnnlydnl/... I'doe,Innd un tare In1nLn• � --- rn T"'
n•r6ntr In �t r.n dpntte�nhh 1511 NCAI'11' III IN,
Q. I ILI.I) Ipplll)f _ �J.__—NiF I I IOD 01'1 l'SIjq-1-R — --
1u. NVA rlat Z014FS (dep(h): —_—_------ 1 Q( NAiQfL SKhCC'll
1)ISItJI'LC 1lON:'f re —Aulo uul_L$ Sllowthlectlon and distance it, Ill1Ic9IIool
11. ticn;l �edl
71 -LA � Iwo Stale (loads or County Roads. Include le road \
12. CASMU 1VsIl"I llickncss
Ilcplh binulcicr or 1VcilthUP1. binlcliod ouulbcrs fold conuntin road onulcs.
I-Imo "fu r �L_ht._S.P `z. 5pi:,31 Pvc--
13. GROUh: 14pII hlnlrlial hlclhod
Ilolll
0—
fl,
nnln
14. SCREW: Ilrplh Slol Sic hlalrtinl — -
hoot
15- SANUlGRAN'I:I, I'ACI''
I)rpdt Sire hbdainl
Flom -I1'__ 11�---- ----------
16. RIJAMY1,S: —_----
11)(, 1I,;I,I:m"CpRnfY HIM 1llls VITLL WAS(1111S I RUGIR1) Ill ACCORDANCE W1111 15A IICAC 2C,W1iLL
CONS IRUCI Iu1J S UANDARDS,AND 1nAr A COPY OFIlll S (RECORD IIAS BEEN PROVIDED 10111L' WELLOWIICR
r — ---- — --- -- -------- t
SI(iIJAlUItI?UFI'IlR50NCUIJS17tUCNNU'f1ll!1gWEhL UA'IL,
Sohnlil the u111;hrll lu the Ill illon 01 W!q(er Quntily,GI oundlvnlcl'Secllun, 1636 Mill Service Ce"1,rt ul lvfu7r t:

/rill) .
nr __
)YEIA, CUNS,I'jtUC 1QN RLC01U 107 Ito
N01111 CaloI it a DcpaI II I I11 of Ihlvilmli nc ul IIId tInl IIlal kc.9 utccs-DiviMuII of Witter QU11Iity-Ol ouudwil Ice Scc I in II
cFlluncnuuN n�`[
wFLl,tarNutnClunplvul\vlunt.)Nnnlepnlnp_-`�/' ---- p�7-,29f7 IYF1.1.CON I RAC I Mt l(IMi'AN 1'NAaIF -------
ASSOC'IAIF.p\v1)PF.IIn1I7 M
if n r dica6lc _
I. WU1 I,USF. tijwuk Applicable IIOS): Itesidculitd I,_ I I'll icipal/Public U Imlu^ttial ❑ A)picu11u1a1 U
M1lonilot ing U Revovcly I I I lad Pump Walcr hljectirnt U Olhct U If Othcr, List Use_
2. w1:1.1, I.00A 11011- / / '11gln�rgdlir/I.nnd scllinl;
CnuW}' _C4� 46_4L' URidge LISlupe ❑Vollry l_ll'lal
IJcalccl IorV1._ �/� --- - (r6rrk nlgnvl unr bile)
1_nlitn4c/lon ilude of well Incatinn
(Sorel Ilnn.r Ilnud rrt,Cnnunnnip 5 d Irvnioq I 1 II,.,lip Cwlr) r os 37. `t[r•
!n/Cl`f Gr:odi/mod f (J<RrtrJuJnuV,'sa'nn,L)
1. 0WHI'R:____—_X 7� L:Ililudc/Imlgiludc sourcc:ERWsOlblmgrapbic nlap
V�17Q�t—�L�+- (elieek Met)
Addlcss ll..__ l y--}----_ .
(SUrrl ar tnn�t lit,) / ))Q U1 I)-If,11.11 I1;-L(IU
--•:411 c11�J��--�1- - �1 0 i--.—..---— Flom ` 'to 1'ouunliou Uc.^.ctipliuu
— l'ilp n,lvnn Slnln 7ip l'o.lc ---y Et
.—
Nrn n.l.- 1'I nvm n..... � O��Q� D6 -�QL S 4 —
5. ImAI IlFPrn:_ 3o Z ___--.----. _ —
G. OC/FS 1\'I:1.1, Itl',I'IAI'h. I?\IS IIIJU \VFI.1,7 }'Ii5ceLI IJIJ 1•I —o
7. S FA I IC WA I I:It LL;V 1i1, Ilclow'fup of firing U ---�
g. .f,•l-n�1 rl' OI° 'AteSmIlN tOr (O•r• 1 I rAliner 1l„nI
ISvFF. Abnvr I.nd n Sr lu"nl•Fi ncc'
C S ' IIIP. —
q,of — InnA mf-r
lntrcrIn4llh 15A NCA -----
---
—
4. } 1I:I.11 (['I'm): -- Nil:/IQ1/1,0D OF'I PS
10. WAI ER i.ONI'S (depth): I(�I�V_I�.h1-L)I
Show dilection and dislnuce in miles Gaol ill Icnsl
1 I. OISIIJFIiCTII)W: Iype�r Aolololl -../ �� two Stale lioads orCotudy Roads. Include the land
12. G\SIIJIi: Nall llli(kilc^s
M1hllcl ial IIt111111ef9 nlid C1111111011 fOed inle9.
I)rl,ltl Dimuclrr or
I'Ivm To
1nlr lal M11cIbuJ
I'u'iIl Lo_ -
14. SCRFFN: Drplll Diameter SIM Sim Malainl
in.
I`1on1
p1I -----
15. SANDIURAVI'I. PACE: t.bdainl
llrplll Sirc
16.
1 DIl I II'I'.I'UY CISIt I IFl"I I IAl"I I II:WFLI,WAS('UPIS11tUC1 F.0 Ill ACCCIRDAIJCI?WI"Ill 15A I ICAC 2C,VTI.I. "
CONS I RUCI IOII S(ANDARDS,AIJD'I IIAt A COVY OI"I111 S Itt:CORD HAS I1GGN 1'ROVIDLDTO fIILI WELL OP;I ICR
"�t�Fi r�'-. - -- — --w
SIliF1AlUItI!UP I'P.IISVN CUIJS71tUCI1NO'11115 WMI, DA'I1,
Sul'mil Ihr o111;1n.11 la the Dll idoa of RV!der lJualtly,CI nuudlrilleF Section, IGI(Mnll Sa-clreC(i\Vrl I!I!V.'117171101

fill/)
310728
WELL CONSTRUCTION RECORD
North Cntolim - DrImilment arm itonn icia and Nalmal Rcsoluces-Division of Wnler Qunlily- OLlnutdwnl" S cc'iun
�,,arr /2eec.e
IVFLI,CON lnncnnl pNulcunml.)NAn1e Ir,hnyl)y�-./ -- --
`cennrICAImr4mAN03
tVF.LL CON II(ACI Olt CIlnlrnNYNAnIF ll>°r�-.-- -. ---Puol+e n b'( .2Y7.837__��9
S I I F.tV F.I,L('NNS I It 1471 ION IT..IUII I __._._..___-____---ASSOCIA I Fit 1VfJ PF.Ilnll I N
if a • �licublc if n , rlicnl,lc .
I. R'FI-I, USL' (Check Applicable Boa): Itcsidrulial { Ahmicipnl/Public U Iodushinl U Agticulhnal U
t`Ionilotiog U Recovcly LI I Icaf I'uugl 1V:drr hljecliuo U 011icr U If 01111C Lisl USC
2. WFI.I. IIWAIION' / Topognphic/Lmldsetlilig
IJcnlccl'Io,vn•�/��� —Coolly Cf7P OL� Midge LlSlupc IJVnllcy Ul lnl
/0Y-Y k4l
(SUerl Ilnmr, lund�n r,(,nnnunily,Snl J,r sion,Ird 11 ,nl l'rrle) La(Ittldellulig11Lde of tVCII Ip[nhnll N
o /
). 1)1C IJI'.It //!%��yG--u UP S __ (drpretJuJnul.ch nml,)
AJJlcss _--�_Q..-j]-CYS_. 1�7-3 —.--------- I_:Ilitmlclloopiludesom U
cc:Ll(;PSR,powni'lliclnp n
(.'. ,rct nr It note Nn.) (check bnm)
Ciq orinvrl $Intr 7;p c,nlr Flom 'to honnnlion lJc.^,ctipliuu
A,rn n.lr. Phan•nnnd•a Jl jO -
A, Iln1I:. URI1,1 I:D 70-- P30
5. 1 I'ALDI:1'I[I!-- S O --- -
6. It()I:S NVI;1,1, It11ITACE 1:XIS1114U W1:1 L1 VI:�LI 140 w
7. S I'A I IC NV 11:It 1.1:V1;1, D _0iclocv 1(111 of('n9iug: . 0 .__—I:1'. —_--n—
L (lire"r"If Ahnvr l op nl 1'nainpl v
FF. Above I.nld Sutfo:C, T
•lrp nl trdnp Irnnlnnled nl/�•r Lrinn lend nnl�re rrgnh rr r ,.�_
vr,lnncr In „ttarArnre nhtr ISA NCAC 1C.1111p, cncn
�IIiIIIOD Uh'I IiS1'_
10. WA I ER ZNNCs OCIV111): Y•4_I-O t —`��q —
it. NISMIT.C1-1011:-1)lie fT/{- nnunnd_�y Show dilectiun mid dislike hI miles liom tit QS1
12. CASING: lv lmonicknccs two SInIc Bonds ur County Runs. hlcludc Ih and
Drplh Din111CICr or 1Vcighl Pl, pinlctial tlulnbcfs and ctnnmon fond unnicq{6���
Ilnnl 0 to
Ilvm fo _--
Ilool to _FL—__-- ---- ----- r-
11. OROU F: Urpth Ll lal �/f.Iclh,
Id. SCRITH: Flrpth H.1111cler !;lot Sin Malclinl
Mont 'io il, ill. ---_ in. — ?q -
Ilool— _ 'to_ 1:1.
15. SAN1110RAVI°I. Pnl'G q
I Irldll ;i10 61nlc1 inl
1711,111 I o--- Ill.---- '------ _._
16. ItISRIAIiI:S: ----
h0 I II:I',I:ItY CI'R tlFY I IIA'I 'I IIIS WILL WAS('UIIS I1llICI lID III ACCORDANCIi Wilt II 15A NCAC 217,tV1a.1•
CONS I RUCI I014 S fANDARDS,AIID'I I IAi A COPY OF•IIIIS RECORD IIAS BEEN PROVIDED 10"IlIL WL:LL OVA I II:R
— SI(ir1A7llltl?OF 1'1lItSON CUIJSI1tUCfIN(1'IIILI WELL DAIL' --
Submit I Itr 1,1 lt,lll'11 to the Ill Won tit 1111ter tJuslily,(:I uuudll•nlcr Seclluu, 1636111n11 Service Ccntcr-Ilnlriplr,rw
,n.1- on A..... li1V-1 Pliv. 01/2001

WELL CONSTRUCTION RECORD 312 , e
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING PHONE is (M)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential X Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ if Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: U County CHEROKEE }Midge ❑Slope ❑Valley ❑Flat
UNAKA VIEW RD(IN SWITC BACK NEAR TOP) (check appropriate box)
(Street Narne,Numbers,Community,Sub(livision,Lot No.,Zip Code) Latitude/longitude of well location
3510.845N/8407.755W
3. OWNER: LARRY MATHEWS (degrees/minutes/seconds)
Address P.O.BOX 1551 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
T M yes FL 33902 DEPTH DRILLING LOG
city o Town r— state zip code From To Formation Description
(;q)-292-2759 V TO 10' BROWN SLATE
Area code-Phone number 10'TO 20' BLUE SLATE
4. DATE DRILLED 05/06/2005 20'TO 1005' SLATE
5. TOTAL DEPTH: 1005'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
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.0118.
9. YIELD(gpm): METHOD OF TEST AIR
10. WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 20 Ft. 6 1/8" SDR 21 PVC `
From To FL N
Front—To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY IQ
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material �(
Fmm To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. �0 2 $5 J R
Front—To—Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL r_--
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD ZHASEEN PROVIDED TO THE WELL OWNER '
r
SIGNATURE OF PERSON CONS CTING THE WELL DATE _,
i
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center- ,.
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/200r*

WELL CONSTRUCTION RECORD 3 12
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING --PHONE # (Slzt)837.8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Mutlticipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: /%uRPI{y County CHEROKEE ❑Ridge Slope []Valley []Flat
JOE BROWN HWY(ON LEFT JUST BEFORE UNAKA VIEW RD) (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: LARRY MATHEWS (degrees/minutes/seconds)
Address P.O.BoX 1551 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
l~o2f- /K)""S FL 33902 DEPTH DRILLING LOG
City or Town State Zip code From To Formation Description
(a3 -292-2759 0'TO 10' BROWN SLATE
Area code-Phone number 10'TO 22' BLUE SLATE
4. DATE DRILLED 0510912005 22'TO 305' SLATE
5. TOTAL DEPTH: 305'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO)4 t�
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use"+"if Above Top of Casing) C -e
8. TOP OF CASING IS 1 FT.Above Land Surface* a
-Top of casing terminated attor below knit surface requires a
N
variance In accordance with 1SA NCAC 2C.0118. m1
9. YIELD(gpm): 10 METHOD OF TEST AIR :
10. WATER ZONES(depth): ut
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least •c
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road tames.
From 0 To 22 Ft. 6 118" SDR 21 PVC
From To Ft._
L eid
From To FL
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY t/
From To FL V'17
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. a�
15. SAND/GRAVEL PACK:
Depth Size Material
From
From To FL u
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL = v
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS ORD S BEEN P OVIDED TO THE WELL OWNER'
SIGNATURE OF PERSON CONSTRUCUr 1 HE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (pMnt) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PRONE N [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WO PERMITN
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential lH J MunicipaVPublic ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: �Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE dRidge ❑Slope ❑Valley ❑Flat
WOLF MTN.ESTATES /�'T To� A!e*R �i'RLE lt.)' 1Ll.IlYv1$ (check appropriate box)
(Street Name,Numbers,Co ity,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: STEVE CROWE (degrees/minutes/seconds)
Address 5510 HWY 64 WEST Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY INC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
g( 28 )_361-2291 Y TO 20' BLACK/BROWN DIRT
Area code-Phone number 20'TO 40' GRAVEL
4. DATE DRILLED 05/13/05 40'TO 43' GRANITE
5. TOTAL DEPTH: 505' 43'TO 505' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 2(
7. STATIC WATER LEVEL Below Top of Casing: 0 FT.
(Use"+"if Above Top or Casing)
8. TOP OF CASING IS I FT. Above Land Surface" c
'Top of casing terminated at/or below land surface requires a n
variance In accordance with ISA NCAC 2C.0118. 1
9. YIELD(gpm): 6 METHOD OF TEST AIR
10. WATER ZONES (depth): 80'-100' — 4"
LOCATION SKETCH ul
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and diskvtce in miles from at le
12. CASING: Wall Thickness two State Roads or County Roads. Include the
Depth Diameter or Weight/Ft Material numbers and common mad names.
From 0 To 43 Ft. 6 1/8" SDR 21 PVC
From To FL _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT GRAVITY
From To FL (�
14. SCREEN: Depth Diameter Slot Size Material
From To FL in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: �71
Depth Size Material
From To FL
From To FL (t914Uw
16. REMARKS: A41:1—PS 114--� CQe LI_
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL c
CONSTRUCTION STANDARDS,AND THAT T A�OPY OF TIHS RF,CORD I S BEEN PR DED TO THE WELL OWNER
SIGNATURE OF PERSON CO STRUCTIN WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004 ;

WELL CONSTRUCTION RECORD `?
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
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 R*"Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE Midge ❑Slope Malley ❑Flat
WOLF MTN.ESTATES- TRANQUIL COVE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,L.ot No.,Zip Code) Latitude/longitude of well location
3. OWNER: STEVE CROWE (degrees/minutes/seconds)
Address 5510 HWY 64 WEST Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
6( 28 )-361-2291 O'TO 20' BROWN/RED SANDSTONE
Area code-Phone m iber 20'TO 40' BLUE SLATE
4. DATE DRILLED 05116/05 40'TO 41' SLATE
5. TOTAL DEPTH: 505' 41'TO 505' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO d
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use"+"if Above Top of Casing) r r
8. TOP OF CASING IS 1 FT.Above Land Surface" c
•Top of casing terminated atlor below land surface requires a t—
variance in accordance with 1SA NCAC 2C.0118. IV
9. YIELD(gpm): 10 METHOD OF TEST AIR
10.WATER ZONES(depth): 400' LOCATION SKETCH Ln
Show direction and distance in miles from at leasf
two Stale Roads or County Roads. Include the roa�I1. DISINFECTION:Type CHLORINE Amount 10o PPM
12. CASING: Wall Thickness
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 41 FL 6 1/8" SDR 21 PVC
From To Ft.
From To Ft. J�
13. GROUT: Depth Material Method GD
From 0 To 20 Ft.CEMENT GRAVITY
From To FL
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. is
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To FL
16. REMARKS: --
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT ACOPY OF THIS RECORD HAS BEE PROVIDED TO THE WELL OWNER
Ufi
5-17_06
SIGNATURE OF PERSON CONSTRUC G WELL DAZE 10
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail service Center-
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days.
GW-1 REV,0912004 _

WELL CONSTRUCTION RECORD 2
North Carolina Department of Environment and Natural Resources-Division of Water Quality \�
WELL CONTRACTOR(INDIVIDUAL)NAME (pr{nl) DAVID F. MCKINNON CERTIFICATION#2411
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. Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE I Ridge ❑Slope ❑Valley ❑Flat
TARHEEL PROPERTIES-LOVER'S LEAP +� (check appropriate box)-
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Codc) Latitude/longitude of well location
3. OWNER: JAMES ROSS (degrees/minutes/seconds)
Address P.O.BOX 928 Lafitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (checkbox)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town state Zip code From To Formation Description
g( L8D-837-5388 V TO 25' DIRT/GRAVEL
Area code-Phone number 25'TO 40' BROWN DIRT/BOULDER
4. DATE DRILLED 05/08/05 40'TO 60' GRANITE/SET CASING
5. TOTAL DEPTH: 705' 60'TO 340' SLATE/GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 340'TO 705' GRANITE
7. STATIC WATER LEVEL Below Top of Casing: 300 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 requtres a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 1/2 METHOD OF TEST AIR
10. WATER ZONES (depth): LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 60 Ft. 6118" SDR21 PVC 4
From To Ft. 27;�,—��vl
From To FL
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Materialz mK
From To Ft. in. in.
Fmm To Ft, in. inry a
15. SAND/GRAVEL PACK: o
Depth Size Material UI
From To FL
From To Ft. v5
16. REMARKS: err siz.l: s (o5Q 'r
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL I
CONSTRUCTION STANDARDS,AND THAT A COPY F THIS CORD HAS BE N PROVIDED TO THE WELL OV*i; L
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. I -
GW-1 RFi'Vl 0912004_--, -

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDMIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP CO., INC. PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ,,( (if applicable)
1. WELL USE(Check Applicable Box):Residential qtl Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ElHeat Pump Water njcction❑ Other❑ If Other,List Use
2. WELL LOCATION: Topetting
Nearest Town: MURPHY County CHEROKEE ❑Ridge Feb.,,Slope ❑Valley ❑Flat
TANGLEWOOD FOREST ' kappropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: TOM SULLIVAN (degreea/minutes/seconds)
Address 3515 HARSHAW RO Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (checkboz)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
8( 28 )- 361-2378 0'TO 20' RED CLAY
Area code-Phone number 20'TO 40' SANDSTONE
4. DATE DRILLED 05/27/2005 40'TO 50' BLUE SLATE
5. TOTAL DEPTH: 805' 50'TO 805' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO X
7. STATIC WATER LEVEL Below Top of Casing: 766
(Use"+"if Above Top of Casing) ,.
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated attor below land surface requires a
2
variance in accordance with i5A NCAC 2C.0318.
9. YIELD(gpm): 0 METHOD OF TEST AIR .n
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the triad
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 60 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. hYi� e�¢JOt9— R-O
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From TO Ft. in. in.
15. SAND/GRAVEL,PACK:
Depth Size Material
From To Ft.
Fmm To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND
^THAT A COPY} THIS RECORD HAS BEEN PROVIDED TO/THE WELL OWNER
; �l LCtXN h1�a�i� 4 CX1tc( ad uA65r
SIGNATURE 9P PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days.
GW-I REV.09/2004
a

NC OIVNER HIM
WELL CONSTRUCTION RE CORD 3 3
Noidi Carolina-Dcpatttneut of Eltvirumneut and Natural Resources-Divisiarl of Water Quality-Oroundwater SeclioiI,,�,//
WELL CONTRACTOR(INDIVIDUAL)NAME (pdnl)\ti)QM2;S
R r 1 r1�n n CERTIFICATION s aT
PHONE 0 a-1 t) �Z-y`�`:7?
WELL CONTMCTOIt COa1rANY NAafE,1l,�rr�'Af rlP\, �^11'-' 1'J-�-�-��y--
STATE WELL CONSTRUCTION rERAII f# ASSOCIATED WQ pEMtlTo
(if n tlicalIc _ .(tfnppltcnhlc) -
1. WELL USE (Check Applicnl)le Uoa): Itcsidculinl hY Mvaicipnl/Public U Industrial ❑ Agt{cullutal
Moaitoting❑ Recovery ❑ 1►cat rally Water Dtjecll0n U Diller Cl If Older,List Use
2. WELL LOCATION: l Topographic/Lmtd Selling
Neatest Town: '0^ COattly( Ya e_�e []Ridge ❑Slope WVaCY ❑Flat
(check approprtale boa)
-' etp - Lalilu ,Io iluJe of well location
(Sorel Name,NmnFen, onunmtily,Subdivielat,Lot No.,Lp Code) ^ 1 pl r ,r �pv p I y (F.7 p
3. OWNER: Y U5 OA 1 V SJ(dertenhalnulectseeefnnd•)
5 t/.. ❑e n. • e S - Lsliludellongitude soutce:OGPSOTopvgrsphic trap
Addresser /�.� Vf{ AIL¢-J-�- -t--- (check boa)
(Stint oF Route No.) ULf''ftl 1?Lt1LtIN L(LQ
MUrDhv � c- Z`5906 —
From To Fomtnlion Ucsctiplion�
City or Town Stale Zip Cale - 106 ' s&t� r�fG!!
Ate ct cde.rhone number --1 n{' - J y5 Yj
4, DATE DRILLED -23—O S
5. TOTAL DEPTII: \tAS'
6. DOES WELL REPLACE EMS TINO WELL? YES El NO Ul-
7. STATIC WATER LEVEL Dclow•fop orcnsing:_gSZ—F F. _ a
(Use-+"If Above Top of Casing) -
B. TOP OF CASING IS__L-- rl••Above Ln"d Surface• `'
•Top of urin!trnnln,ded fit/or bdon land rurtace rtquh n
O I
vat lance In accord Plitt nllb 15A NCAC IC.oils.
9. YIELD(gpnl):6_METIIOU OF TEST & �71
to.WATER ZONES(depill): LOCATION SKBTCJI
Amotnd 1< Show direction distance in miles from al least
It. DISINFECTION:Type
Wall Thickness two State
Rd
le Roads or County Roads. Include We road
12. CASING: g numbers alld colllmon toad names.
Dcpol Diautcter or Wei hUFI. Material
Front_ ToiaLL 171•Ssr3.11" - <IDC — t„ c��
Front To FI.
Fronn To FL U{�s
rA
13. GROUT: Depth T le
k lta) McUwJ
Fron _To Fl.
S oY
Flittli ab Ft. x
14. SCREEN: Depot Dimneler Slot Size Material
Ftotn To Ft. in. in• 1 I Itp*
Front Tu Ft. In.
15. SAN D/GRAV El.PACK: _
Depill Size Mntelinl
Floral Fi FL
From •Ib Fl. �t-c,,>
16. REMARKS:
I DO IIEREDY CERTIFY T1IATTIIIS WELL WAS CONS'IRUCI FD IN ACCORDANCE WITH 15A NCAC 2C,WP.LL_
CONSTRUCTION STANDARDS,AND TIIAT A COPY OF TIIIS RE-CORD ILAS BEEN PROVIDED TO TILE WELL OWNER
_ 5-
SIUNATUILE OF PERSON CONS"IRUCTINO TIW WELL DATB
Subinit file original to (he Division of Water Quality,Groundwater Sections 1636 Mail Service Carr'RVg07NC
- - - -. ,,,t ...tn.t..•trl a,.,•.

0IPNEIt hlll'U — _---
WELL CONSTRUCTION RLCOItll
NorW Carolina-Deparunent of Environment mid Natural Resources-Division ur Water Quality-Oroundwalcr Section
WELL CONTRACfOn(INUIYIUUAL)NAME (prLJ)y)QYI^ C:� Q l 1'I Soil CERTIFICATION Rd 51
WELL CONTRACTOR COMPANY NAME M;)l P C iw)12�1 A `,`\"hQ rIIONE R tB-=Y) f(3Y-�997
STATE WELL CONS MCI ION PERAITTr ASSOCIAI Fit WO PERM11-10 .
(if nl l lien(ic) (if npplicnblc)
►, WELL USE(Check Applicable Box): Residcolial ItYMunicipal/Public❑ Industrial CI Agricultmal L7
Monitoring C3 Recovery 0 licat pump Water Injection❑ 011fer 13 if Outer,List Use
2. W ELL LOCATION: TopographidLand -.tiling
cares(Town: Cuuulyc-ylp�31 [Mdge C1SIupe Malley ❑plat
ii!5 (check appropriate box)
(Sues(Name,Nanben,Canr oily Subdivision.Lot No.,Zy,Care) Latilude/lungilude of well
y locslimr
aq �0 x�74 , 1�O3/s
3. OWNER: (degreee/minuteilieconde)
Address Lalituddlongitude source:EIGPS11'ropogtaphic Wrap
(check box)
(Sbeet a Route No.)
G J t2 l" A/C Z &4 0l J&M 1ztt��41N_S�LVt
City or Town Stele Zip Cale Front To Formation DCSCIIpIi
On ,
rn - Ini
Area cafe-rlmne number __.i n '
4, DATE DRILLED 5 - 21 C 6 Inn' - CA I r <n
5. TOTAL DEPTII: Or01'
6. DOES WELL REPLACE EXISTINO WELL? YES O NO 111-
7. STATIC WATER LEVEL Below Top of Casing: DTl_I`r. r
(One*'+"If Above'Top of Casing) -
8. TOP OF CASING IS I rr. Above Lmal Sol face" .� g
-Top of cnlne letrnlnaled atior below land surface teclurles a
♦aslonce In accordance with ISA NCAC 1C.a1IR. rs
9. YIELD(gpni): 1 METHOD OF TEST d'9
10.WATER ZONES(depth): LOCATION SK11101
CASING: Wall
lliickncss
Show direction and distance in miles frmn at least
IZ. C
I1. S ION:Type h Al lint l o two Stale Roads or County Roads. include We road
CASING:
Dcplh Dinuretcr or WeighUFl. Malelial nmubers acid conunon road names.
From C) To l l r] ' I-(" (a,D-5 v(
Front To FL rc,:r4Qve(l
From To FL 1i •r.�o?
13. GROUF: DepW h1nletial MCCCW'ord� ed
Ftont__(�L_To ft.�
From To a a
o' Ft. S
��,r__,r,,�`
14. SCREEN: DepW Diameter Slot Size t "Mate l x
Front To rt.—ill. in.
Front 'I'o FL—in. iu.
15. SAND/GRAVI?LPACK!
Urpih Size Mnlelial _. ._.
Front 1'o FL
Front To FL �j
Ji en.r) P.d
16. REMARKS:
I DO IIEREBY CERTIFY TIIAT TI IIS WELL WAS CONS'I'RUCI'ED IN ACCORDANCE Will[ 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TIIAT A COPY OF 71IIS RECORD IIAS BEEN PROVIDED TO711E WELL OWNER '
_ S- 11 - a
SIGNATUIIE OIr I'EItSON CONS'i"RUCI'INO T11E WELL DAIL'
Subudt the orlglunl to the Divislon of Wnter Quallty,Cruuiidwo(er Secllon,1636 Mall Service Ceii(er-Itnielgll,NC
...�., ..v nr._.._u., rotor�tl»)1 w11Llu TII Jnt•e OW-1 REV.07/2001 ,•

NC _ V 0IVNER MII'0
Y 4� •1 •i
WELL CONSTRUCTION RLC01M
Nordl Carolina-Deparhnenl Of Envirurwlent and Natural Resources-Division of Water Quality-Groundwaler Sectioon�/�
WELL CUNT RAC(OIJ(IND IVIDUAL)NAaI E (ptIolZ5 V1AQL la7 1S^v'� CERTIFICATION I,�_y
LVELLCONTRACIORCOMrANYNAb1E 'vn rtI P ".,ll /�r�((vVLQ ruone a [v7rr)sri-: 7
STATE WELL CONSTRUCTION VERAIITN ASSOCIATED WQ PERMITO
(ifniplicnUc) (ifnpplicahlc) -
1. WELL USE(Check Applicable [lox): Itesidculial Ip/Municipalfl'ublic U Industrial U Aglicultwal U
Monitoring[] Recovery U llcal Puwp Water Injection U Other C) If odler,List Use
2. WELLLOCATION: �/Jopogrnphic/Landselling
Nearest Town: Couny Wtltldge USlope []Valley ❑Plat
(check approptlele box)
Lali5luddloll elude of well IocatierlN
(Sucet Ner ie,Nmnben,lComnmv y,Subdivision,
Lot No.,Zip I-Ogle) �3e rnC l w8'i e 8 r$O
ER:i( I I �h t/O dogbil 6111 e S (degreeshninnlrr/eeeondt)
3. OWN 5 U 5 Laliludellongilude source:UGPSUTopugraphic map
Address (check box)
(Street OF ReAte No.)� le A)C ZF590 ,.- �IN� C LQQ
MAr .5 From To Formation Description
Cityor Town Slate Zip Code
L.—)
Ara cede-f hone number
4. DATE DRILLED( - 26,
5. TOTAL DEPT[1: -zdw' -
6. DOES WELL REPLACE EXISTING WELL? YES U NO L _
7. Sl'ATIC WATERLEVEL Uclow'I'op ofCasing: 5(0 r1'.
(Use"+"If Above l'np of Caxhrg) -B. T01t 01'CASING IS__I t-1•. Alcove Lnnd Sulfacce
aTop of toting tertnlnatrd aUor brlow land surhte tequlr is a =�
♦atlonte In actordsnee with 15A NCAC 2C.01 la. r n
9. YIELD(gpm): 3 _METHOD OF TEST R
10.WATER ZONES(depth): t.00A'C�pN SKEiC)1 -"
It. DISINFECTION:Typeh tT Amount M Show direction and distance in miles from at least
12. CASING:
Wall Thickness two Slate Roads or County Roads. include We road
Dcpd, Diameter or Wcighllhl. Material numbers and coaunon road names.
From _0 To��l'f• (o.as ( �r —
From To Fl. d4�
Flom To FL
13. GROUT: Depol 1ale,ial Mediod
Fran,—e-) Tu--ao'r•L rp_ssucp _ H„
a
From To—rt. C,r.p s
14, SCREEN: Depdr Uituncter Slot Size Material S
From Tn Ft.—ill.
rtom Te__
15. SANDIGRAVlil,l'ACK: lee
Or Pill Size Mnledal 's1
To Ft. — �"a
16. REMARKS:
1 DO HEREBY CERTIFY MAT TIIIS WELL WAS CONSTRUCIED IN ACCORDANCE WIT11 15A NCAC 2C,WELL
CONSI UCTION STANDARDS,AND THAT A COPY OF'rlllSRECORD IIAS BEEN PROVIDED TO TIW WELL OWNER
SIGNATURE UI'1'BRSUN CONS'1'RU(.'1'INU 711E WELL DATE
Submit the of lghlal to the Divislou of Water Quality,Groundwater Sec111011,1636 hall Service Cculer.•Italelgh,NC
171I vvllhh, TIl dav9. OW-1 RLIV,0712001

OIVNEIi milli) _______
He
WELL CONSTRUCTION R1:CORll W 3 1 cl
Notdt Cat olina-Dcpalhncul of Envirmuueat and Natural Resources-Division Of Water Quality-G water Section
1oy
i(`
ERTIP
{YELL CONTnACfOli(INDIVIDUAL)NAME (prhu) s 29Q1
\ _.11' r,A _PIIUNE a If>Y14i7-
WELL CONTRACIOR C01%1PANY NAME A��-(�
ASSOCIA-1 ED WO PE.M11T"N
STATE WELL CONS lRUCrWN PEM IITM i(a r rlicnblc
if n+rlicnblc
1. \YELL USE(Check Applicnblc Dux): Residcolini U Muuicipul/Public U Industlial CI Aglicullutal CJ
hlonituring U Recovery ❑ Rent Pmop Water 1lljeclion U Other U If OWcr,List Use
TopogrnphielLand Selling
2. WELL LOCATION:
Nearest Town: Vh .r CoulllyCl0
-- PCo1Ge2 Ultidgo ❑Slope L9 UFlal
(check sppropdnle bull
Lnlitudellongilude of well location
(Sueel Name,Number,Commmtily,Sabdivislar,(Al No.,Zip Code) N�So ,��9 �, gy"�t �+
Sl
3. OWNER: a l (deeeet/mioutedcnndc)
Latiluddlongilude source:UGPSUT O pographc nap
Address e- e De (check box)
(Saco a Route No.) 3'T 70 -ll MLL.►NG L(ZCL
Gq tiro n CrA 30 I i r+ Ftom To Fominlion Dcscliption
City or Town Stale Zip Cale D - T , A
Arcs code-rhone number .305
4. DA7-13 DRILLED s a5- OS
5. TOTAL DEPTH: -S0S '
6. DOES WELL REPLACE II-XIS1'INO WELL? YES ❑ NO U
7. STATIC WATER LEVEL Below Top of Cnsing: lD C1'. C
(Use"+"If Above Tbp of Cseinx)
B. TOR' OF CASING IS I vie.Above Land Sol race* cn
.lop or taslnr lernolo+led ml.r below land mi-ce rrqul,n a
vstlsnce In sctordsnct with ISA NCAC 2C.011e. C"
9. YIELD
(�pot) _�_nt13 ruou of TEST�k u'
10.WATER ZONES(depth):
1 ---�-- Alllurint \a `— Show direction and distance in miles from a(lead
11. DISINPECTION:'Cype�Wall Thickness two Stale Roads or County Roads. Include the r ad
12. CASING: numbers and collation toad names.
DepUl Uiatnelcr or WcighUFl. Material
Front 0 To _FL 4,116-- -21 Pile—
Ftom To Ft.
From To FL .,,rtt( cri p
17. GROUT: Depot h aletial McWoJ
FfolnL-D—TO .2D, Ft. \
From To Ft.
14. SCREEN: Depot Diameter Slot Size Material ewe t l
Front
To Fl. in. in.
Frool_ To—FI. in. )U.
15. SAND/GRAVEL PACK:
Depol Size Malellal
Front T, FL ,;°� _
Ffenl
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCI LID IN ACCORDANCE WITH 15A NCAC 2C;WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF TIIIS RECORD HAS BEEN PROVIDED TO TIIE WELL OW14ER
5- a5- o
SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original lO the Divislou Of Water Quality,Groundwater Section,1636 Mall Service Cr'OW- REV. NC
07 2001 '

WELL CONSTRUCTION RECORD 13 3 2 e;
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prmt) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP CO.,INC. PHONE # (e)$)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
IMMENSE (if applicable) (if applicable)
1. WELL.USE(Check Applicable Box):Residential P( MunicipaliPublic❑ Industrial❑ Agricultural ❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
F
2. WELL LOCATION: Topographic/Laud setting �
Nearest Town: MURP}4,V County CHEROKEE ❑Ridge ,Slope ❑Valley C'�at
REDDEN RD TO CROSS CREEK -• a7,7 Qe,.) $ ck'` �+T0.1-- (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well locatird
CO
3. OWNER: SITYLAN&LISA MOSS (degrees/miautes/seconds) O
Address 178 PALMER LN Latitude/longitude source:❑GP$❑TopogM hic no
(Street or Route No.) (check box)
MARSLZ NC 28905 DEPTH DRILLING LOG L-,B
City or Town state Zip code From To Formation Description
(7eCo)-455-8300 0'TO 20' RED/BROWN DIRT
Area code-Phone number 20'TO120' SANDSTONE
4. DATE DRILLED 06/03/2005 120'TO 148' MARBLE
5. TOTAL DEPTH: 285' 148'TO 16V MARBLE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO ❑ 165'TO 185' UNCONSOLIDATED
7. STATIC WATER LEVEL Below Top of Casing: 50 FT. 185'TO 195' MARBLE
(Use"+"if Above Top of Casing) 195'TO 227' MARBLE
8. TOP OF CASING IS 1 1/2 FT.Above Land Surface* 227'TO 251' UNCONSOLIDATED
-Top of casing terminated at/or below land surface requires a 25V TO 285' MARBLE
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 30 METHOD OF TEST AIR 145 r ro �4Z5" " NOLC
10.WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Arimunt 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 195 FL 59116" .156 STEEL
From 0 To 148 Ft. 6 1/8" SDR 21 PVC
From To Ft. O'
13. GROUT: Depth Material Method R
From 0 To 20 Ft CEMENT GRAVITY C
From To Ft.
14. SCREEN: Depth Diarneter Slot Size Material
i
From To Ft. in in
From To Ft. in. is
15. SAND/GRAVEL PACK: ?
Depth Size Material
From To Ft.—
From—To—Ft. H� Cci( WH 5T
16. REMARKS: S°T PU.vIP fN CisSaaG
I DO HEREBY CERTIFY THAT TH[S WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WlttLL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS REC HAS PROVIDED TO THE WEL�OWNER
�� � L
SIGNATURE OF PERSON CONSTR TING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mad Semc�Leq r-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GWf V.01/2004
L I

r.
WELL CONSTRUCTION RECORD �"� .� 4. .9
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRAcrORCOMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMrr#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential� Municipal/Public❑ Industrial❑ Agricultural q-
Monnoting El Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Laud sorting
Nearest Town: MURPHY, County CHEROKEE (Ridge ❑Slope ❑Valli f7Flat-
PUETT COVE-RICE LN (check appropriate boar)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudcAongitude of well locnrion
3. OWNER: THE BERG GROUP, LLC. (degrees/minutes/seconds).
Address 75 MOUNTAIN OVERLOOK DR Latitudc/longitude Source:❑GPSQToppographic.map
(Street or Rome No.) (check box) i L- -_-_ --—
MURPHY, NC 28906 DEPTH DRILLING bG--
City or Town State Zip Code From TO Fon nation Description
676-8965 O'TO 20' RED SANDSTONE
Area code-Phone number 20'TO 100' BROWN?AN SANDSTONE
4. DATE DRILLED 06/17/2005 100'TO 137' BLUE SLATE
5. TOTAL DEPTH: 805' 137'TO 805' SLATE 't'1
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO A
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface* N
*Top of rasing terminated Wor belay Lund surface requires a 69 _
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 4 METHOD OF TEST AIR w=�
10.WATER ZONES(depth): 380',5W
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 TO 137 Ft. 61/8- SDR 21 PVC
From To Ft. ^�
From To Ft. N e
13. GROUT: Depth Material Method L 1
From 0 To 20 FL CEMENT GRAVITY
Fmm TO Ft. 4
14. SCREEN: Depth Diameter Slot Size Material
From TO Ft. in. in.
From To Ft. in- in.
15. SAND/GRAVEL PACK:
Depth Size Material p1
From To Ft.
From To Ft. Nwy y/
16. RIDAARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT�F THI RECO HAS PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUVNG THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACrOR(INDIVIDUAL)NAME (print) DAVID F. MCKINNON CERTIFICATION#2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. pHONE # (g'] )837-8008
STATE WELL CONSTRUCTION PERNUT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential) Mumcipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Top o raphic/Land setting
Nearest Town: /huKPHl County CHEROKEE ❑Ridge pope ❑Valley ❑Flat
HAWTHORNE ESTATES-AMANDNS WAY (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3510.772N/8356,101 W
3. OWNER: STEPHEN&NANCY LAFAZIA (degrees/minutes/seconds)
Address 11310 NW 41ST STREET LatitudeAongitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
$4W R 15 C' FL 33323 DEPTH DRILLING LOG
city or Townt state Zip Code From TO Formation Description
(ILIJ)-7464966 0'TO 6V BROWN DIRT
Area code-Phone number 65'TO 80' SLATEIGRANITE
4. DATE DRILLED 06/13/2005 80'TO 130' BLACK SLATE/GRANITE
5. TOTAL DEPTH: 305' 130'TO 165' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO jX 165'TO 305' SLATE/GRANITE to
7. STATIC WATER LEVEL Below Top of Casing: 150 FT. C -
(Use"+"if Above Top of Casing) C
S. TOP OF CASING IS 1 FT.Above Land Surface"
-Top of casing terminated at/or below land surface requires a _
vartatrce in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 3112 METHOD OF TEST AIR
10. WATER ZONES(depth): 140', 160' BIT SIZE-6.119 caSu�
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at leastt�a
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 80 Ft. 6 1/8' SDR 21 PVC
From To Ft. v�
From To Ft. ,
13. GROUT: Depth Material Method
From 0 To 20 Ft CEMENT GRAVITY
From To FL_
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in. r ;�
15. SAND/GRAVEL PACK: 9 r
Depth Size Material
From To Ft.
From To Ft.
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 IIE114 PROVIDED TO THE WELL OWNER
v1.dN�.
SIGNATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center.
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. -
GW-I REV.09/2004

WELL CONSTRUCTION RECORD ( 31 31
North Carolina Department of Environment and Natural Resources-Division of Water Quality 3
WELL CONTRACTOR(INDIVIDUAL)NAME (prme) DAVID F. MCKINNON CERTIFICATION#2411
WELL CONTRACTORCOMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # (828)837-BOOB
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMrr#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Mumcipai/Pub is❑ industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MARBI.0 County CHEROKEE (Ridge ❑Slope ❑Valley ❑Flat
BLUFF RD. (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudcAongitude of well location
3510.808N/8356.122W
3, OWNER: BRUCE TURNBULL C/0 JUSTIN WILLS (degrees/niinutes/seconds)
Address 209 GUY ELLER RD Latitude/longitude source:❑GPS❑Topogmpbic map
(Street or Route No.) (check box)
pf NC 28906 DEPTH DRILLING LOG
ucii or Town state Zip Code From To Formation Description
8( 28 )-361-5819 0'TO 80' BROWN DIRTISANDSTONE
Area code-Phone number 80'TO 100' GRANITE
4. DATE DRILLED 06/10/2005 100'TO 605' BLACK SLATE/GRANITE
5. TOTAL DEPTH: 605' In
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 150 c_
(Use"+"if Above Top of Casing) Z
8. TOP OF CASING IS 1 FT.Above Land Surface* ro ft)
•Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 21/2 METHOD OF TEST AIR o
10. WATER ZONES(depth): 180',580' BIT SIZE-6.085 V 1
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 100 Ft. 6 1/8" SDR 21 PVC
From To Ft. N' t�
From To Ft. ?(k
13. GROUT: Depth Material Method
From 0 To 20 Ft CEMENT GRAVITY
Front-To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in
15. SAND/GRAVEL PACK: �V
Depth Size Material �!
From To Ft. nrQ bn�l
From To Ft.
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 TfIlS ORD BEEN OVIDID TO THE WELL OWNER
slGNATuRE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center;'
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. -
GW-I REV.09/20o '::

WELL CONSTRUCTION RECORD 3 1 312 2
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDWIDUAL)NAME (print) DAVID F.MCKINNON CERTIFICATION#2411
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMTr#
if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: /f?/}/ZF3L-t= CountyCHEROKEE Ridge ❑Slope ❑Valley ❑Flat
BLUFF RD. (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3510.772N/8356.101 W
3. OWNER: KEVIN WATSON (degrees/minutes/seconds)
Address R-0 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) ,� (check box)
��AQDI NC r�j'p y DEPTH DRILLING LOG
City or Town state Zip Code From TO Formation Description
8( 28 )-837-2502 0'TO 20' RED DIRT
Area code-Phone number 20'TO 30' BROWN DIRT
4. DATE DRILLED 06/10/2005 30'TO 40' GRANITE
5. TOTAL DEPTH: 205' 40'TO 205' GRANITE --
6. DOES WELL REPLACE EXISTING WELLY YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50
(Use"+"if Above Top of Casing) (�
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated attor below Ind surface requires a
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 7 METHOD OF TEST AIR qj
10.WATER ZONES(depth): 160' BIT SIZE-6.119 0 -
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at lei
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common
From 0 To 40 Ft. 6 118" SDR 21 PVC
From To Ft.
From To FL
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 FL-
From-To- )r7o )
Ft. RPpRT
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELI. —-
CONSTRUCTION STANDARDS,AND THAT VPY THIS RECORD EEN ROVIDED TO THE WELL OWNER i
SIG PERSON CONSTRUCTING THE WELL DATE =
Submit the original to the Division of Water Quality,Attn:information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. - -
GW-1 REV.,09/209
i

WELL CONSTRUCTION RECORD 313 17 r bjC)
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (paimt) WILLIAM BRADLEY LEWIS CERTIFICCATION#3368
WELL CONTRACIORCOMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. pHONE # (Qj$1837-8008
STATE WELL CONSTRUCTION PERMPr# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential A Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Mt4APky/ County CHEROKEE rdge ❑Slope ❑Valley ❑Flat
BUCK MTN.ESTATES-LOT 11 ` (check appropriate box)
(Street Name,Numbers,Community,Sub(hvision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: PAUL S.AVRATIN (degrees/minutes/seconds)
Address 276 CODRINGTON DRIVE Latitude longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
FL 33308 DEPTH DRILLING LOG
City or Town stair Zip Code From To Formation Description
(_75y)-394-8886 0'TO 20' BROWN DIRT
Area code-Phone number 20'TO 60' GRAVEUSAND
4. DATE DRILLED 06/09/2005 60'TO 75' GRANITE
5. TOTAL DEPTH: 605' 75'TO 605' GRANITE =x�'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO r
7. STATIC WATER LEVEL Below Top of Casing: 50 FT.
(Use"+"if Above Top of Casing) C
8. TOP OF CASING IS 1 FT.Above Land Surface*
*Top or casing terminated atlor below,Lund surface requires a Pa
variance in accordance with 15A NCAC 2C.Olt& -
9. YIELD(gpm): 9 METHOD OF TEST AIR a :ur
10.WATER ZONES(depth): 120',380' Ln
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at Ica
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft Material numbers and connrion road names.
From 0 To 75 Ft. 6 1/8- SDR 21 PVC .p7
From To Ft.
From To Ft. 1
13. GROUT: Depth Material Method } Ji 4 2 �
From 0 To 20 Ft CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material S
From To Ft. in in.
From To Ft. in in
15. SAND/GRAVEL PACK: D
Depth Size Material
From To Ft.
From To Ft. 1
16. REMARKS:
t
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL '
CONSTRUCTION STANDARDS,AND THAT A C Y OF THIS RECORD S BEEN VIDED TO THE WELL OWNER
SIGNATURE OAF CONSTRUC WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Man Service Cent er=;
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. - !,
GW-1 REV.109/2004

WELL CONSTRUCTION RECORD �..7.
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prat) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # (r7$)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential Jj MumcipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: /hctKPHy County CHEROKEE Ridge ❑Slope ❑Valley ❑Flat
BUCK MTN. ESTATES-LOT 1 (check appropriate box)
(Street Name,Numbers,criminal Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: PAUL S.AVRATIN (degrees/minutes/seconds)
Address 276 CODRINGTON DRIVE LattmdeAongitude source:❑GPS❑Topographic map
(Street or Route No.) (check box) .
t $T$ t FL 33308 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
(95JE-394-8886 U TO 20' REDrrAN SLATE
Area code-Phone number 20'TO 40' SANDSTONE
4. DATE DRILLED 06/13/2005 40'TO 60' BLUE SLATE
5. TOTAL DEPTH: 805' 60'TO 805' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO�trtf f
7. STATIC WATER LEVEL.Below Top of Casing: 50 FI.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 Fr.Above Land Surface* c
-Top of easing terminated atlor 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): 120' `
LOCATION SKETCH cn
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at lea
12. CASING: Wall Thickness
two State Roads or County Roads. Include the t
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 60 Ft. 6 1/8" SDR 21 PVC (x )
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY
From To Ft.
14. SCREEN: Dep h Diameter Slot Size Material
From To FIL in in. J
From To Ft. in. in. C9
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. Z
From To Ft.
16. REMARKS: — -
_ . .. -1
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH 15A NCAC 2C,WE ar_
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS PROVID TO THE WELI �11F I1F.R
Co-IG-�
SIGNATURE OF PERSON CONS C G THE WELL DATE T
Submit the original to the Division of Water Quality,Attn:Informatiun Management,1617 Mail Service _
?�
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. -
GW- M.09/1064

WELL CONSTRUCTION RECORD `&
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDMIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3388
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PRONE # ( )837-BOOB
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ���,,,...ttt Municipal/Public
applicable)
1. WELL USE(Check Applicable Box):Residential Mucipal/Public ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water I jection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: At4 County CHEROKEE Ridge ❑Slope ❑Valley []Flat
POEY PLACE (check appropriate box)
(Street Name,Numbers,Ccanmunity,Subdivision,Lot No.,Zip Code) LatimdcAongitude of well location
3. OWNER: ROGER TILLMAN (degrees/minutes/seconds)
Address 7330 NECTAR LN Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
T+aQ He+d�Ts FL 32656 DEPTH DRILLING LOG
city or Town State Zip Code From TO Formation Description
(31j2)_4734897 Y TO 20' RED CLAY
Area code-Phone number 20'TO40' SANDSTONE
4. DATE DRILLED 06-23-2005 40'TO 66' GRANITE r3
5. TOTAL DEPTH: 265' 66 TO 265' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO G 4
7. STATIC WATER LEVEL Below Top of Casing: 50
(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 accordancewith SSA NCAC 2C.0118.
9. YIELD(gpm): 12 METHOD OF TEST AIR
10. WATER ZONES(depth): 120',240'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads-Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 66 Ft. 6 1/8" SDR 21 PVC
From To Ft. P _
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY
From TO Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. 4a
From To Ft. in. in. tv
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A QOPY OF THIS CORD S BEEN P VIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTFP THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail$e 'Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. ----- --- -r I I
0
1'REV.09/2004
0 2005
j' 1

WELL CONSTRUCTION RECORD 3
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
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 Mumcipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE Ridge ❑Slope ❑Valley ❑Flat
PIED PIPER(121 HIGH RIDGE RD) (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3501.777N/8411.566W
3. OWNER: BARRY HART C/O ROGER DRYMON (degrees/mumtes/seconds)
Address 2770 CANDY A" RD Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
8( 28 )_ 361-3700 0'TO 10' RED DIRT
Area code-Phone number 1 O'TO 20' SANDSTONE
4. DATE DRILLED 06/28/2005 20'TO 26' BLUE SLATE
5. TOTAL DEPTH: 605' 26'TO 605' SLATE -�
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 150
(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): 1 114 METHOD OF TEST AIR c11
10. WATER ZONES(depth): 500'-600'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least ;+
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From O To 26 Ft. 6 1/8- SDR 21 PVC
From To Ft.
From To Ft. b�'
13. GROUT: Depth Material Method
From 0 To 20 Ft CEMENT GRAVITY �71
From To Ft a +'
14. SCREEN: Depilr Diameter Slot Size Material �' k
From TO Ft. in. in. Qf1
From To Ft. in in. D(
15. SAND/GRAVEL PACK: �� 1
Depth Size Material
From TO Ft.
From To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COP OF THIS REC HAI BEEN PRO TO THE WELL OWNER
_0
SIGNATURP OP PERSON CONSTRUCTING_TYEII DATE
Submit the original to the Division of Water Quality,Attn:InfolmationlManagemeat,1617_M d*r* vlteCenter-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days
i_' 2005 6YV.!REV.09/2004

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # (g.4)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Resideffiale Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring El Recovery ❑ Heat Pump Water lection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Mgat� County CHEROKEE ❑Ridge XSlope ❑Valley ❑Flat
WILSCOTT RD TO SUNRISE MTN (check appropriate box)
(Street Narne,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3505.077N/8400.724W
3. OWNER: GLENN SMETZER (degrees/minutes/seconds)
Address 219 BRENTWOOD LN Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
/nAt>tSs^J AL 35758 DEPTH DRILLING LOG
City or Town State Zip code From To Formation Description
468-3653 O'TO 20' RED SANDSTONE/SLATE
Area code-Phone number 20'TO23' BLUE SLATE
4. DATE DRILLED 06/21/2005 23'TO 605' BLUE SLATE
5. TOTAL DEPTH: 605'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO J�
7. STATIC WATER LEVEL Below Top of Casing: 60' FT.
(Use-+"if Above Top of Casing) =.4
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): 1 METHOD OF TEST AIR r n
10. WATER ZONES(depth): 60'
LOCATION SKETCH t31
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 23 Ft. 61/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method I J IS
From 0 To 20 Ft CEMENT GRAVITY
From To FL 41 ,r
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, a 1 S CG 1 h
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 REC HAS BEEN OVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUC TT&WELL DATE
Submit the original to the Division of Water Quality,Attn:Informatitiq Manapzemmt4617 Mail S00ce Center-
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days.
OWrl REV.09/2004
00-
- 1

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION 3368
WELL CONTRACTORCOMPANY 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 l/Pub Municipalic❑ Industrial❑ Agricultural❑
Monitoring El Recovery ❑ Heat Pump Wate In3ection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge ❑Slope alley ❑Flat
30 BEE TREE LN (check appropn to box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: ROGER COPENHAVER (degrees/minutes/seconds)
Address 30 BEE TREE LN Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
B( 28 )_837-3848 O'TO 20' RED DIRT
Area code-Phone number 20'TO 40' SANDSTONE
4. DATE DRILLED 06/24/2005 40'TO 63' BLUE SLATE
5. TOTAL DEPTH: 305' 63'TO 305' SLATE ..,.,
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOI
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* G
*Top of casing terminat,4 af/or below land surface requires a F �
variance in accordance with 15A NCAC 2C.0118. r
9. YIELD(gpm): 20 METHOD OF TEST AIR
10. WATER ZONES(depth): 89,240' BIT SIZE 6.012"
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least,
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 63 Ft. 61/8" SDR 21 PVC
From To Ft. —�
From TITFt. J]
13. GROUTDepth Material Method
From 0 To 20 Ft CEMENT GRAVITY Q
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. w
From To Ft. in is
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH I5A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A O OF THIS WORD HAS BEEN PR ED TO THE WELL OWNER
SIGNATUIXE OF PERSON CONSTRUCTINGr WELL DATE
Submit the original to the Division of Water Quality,Attn:Idinrinstion Managethent,1617 A 1�15ervice Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days _
�GW-I REV.09/2004
20
t--
rRrnm�rnariFn crr7�nal

WELL CONSTRUCTION RECORD
North Carolina Department of Errviromrent and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) ,t (if applicable)
1. WELL USE(Check Applicable Box):Residential Murd l/Pub cipalic❑ Industrial❑ AgnCultmal❑
Monitoring❑ Recovery ❑ Heat Pump Water nlection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo phic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge lope ❑Valley ❑Flat
OWL CREEK RD TO PEGGY'S LN (check appropriate box)
(Street Name,Number:,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3509.494N/8401.954W
3. OWNER: STACY HUGHES (degees/nunutes/seconds)
Address P.O.BOX 623 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28 )-837-2781 O'TO 20' RED DIRT
Area code-Phone number 20'TO 23' GRAY GRANITE
4. DATE DRILLED 06/24/2005 23'TO 305' GRANITE
5. TOTAL DEPTH: 305'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 1W
(Use"+"if Above Top of Casing) 'a-
8. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface requires a r= r•+
variance in accordance with ISA NCAC 2C.0118. r '
9. YIELD(gpm): 20 METHOD OF TEST AIR n
10. WATER ZONES(depth): 300'
LOCATION SKETCH ��—
s
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at leash
12. CASING: Wall Thickness two State Roads or County Roads.Include the top
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 23 Ft. 6 1/8" SDR 21 PVC
From To Ft.
-
From To Ft. ,©
13. GROUT: Depth Material Method Q /
From 0 To 20 Ft CEMENT GRAVITY T
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material �7
From To Ft. in. in.
From To Ft. M' in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. 00
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COPY OF THIS CORD BEEN PRO.WED TO THE WELL OWNER
t fry �' Q "-CAS
SIGNATURE OF PERSON CONSTRUCTING L DATE
Submit the original to the Division of Water Quality,Atln:fdflo ►atiod Manag�lglt,1617 Mad Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 di s.. r -- -- --
i' GW-1 REV.09/2004
L__

WELL CONSTRUCTION RECORD I '
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (pang DAVID F. MCKINNON CERTIFICATION#24'I1
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 MumcipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: v Mope
setting
Nearest Town: !1'IURPh{e County CHEROKEE IY1Ridge ope ❑Valley ❑Flat
RACOON RIDGE,TAKE LEFT FORK,GO TO END OF RD '` (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3505.459N/8354.749W
3. OWNER: HAROLD WILSON (degrees/minutes/seconds)
Address 2505 HWY 141 Latitude/longitude source:❑GPS❑Topographic map
(street or Rome No.) (check box)
/)74QPLC- NC 28905 DEPTH DRILLING LOG
City or Town state Zip Cede From To Formation Description
8( 28 )-837-5082 O'TO 20' GRANITE
Area code-Phone number 20'TO 605' GRANITE -0i
4. DATE DRILLED 06/29/2005 z
5. TOTAL DEPTH: 605'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO J� G
7. STATIC WATER LEVEL Below Top of Casing: 150' FT. —�
(Use"+"if Above Top of Casing) 1
Ln ­
8. TOP OF CASING IS 1 FT. Above Land Surface*
9
'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): 160',220'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 20 Ft. 6 1/8• SDR 21 PVC (`X%•"`
From To Ft.
From To Ft. �y4v
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT GRAVITY -Cpd7
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in G);
15. SAND/GRAVEL PACK: b
Depth Size Material Q
Front-To-Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY O THISCORD HAS BEEN PROVIDED TO THE WELL OWNER
I� 3o-es
SIGNATCJRE OF PERSON CONSTRU TING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: Service Center-gem Man Service
Lta'ptip8tloa Management, Ma
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days. , -
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 3I ;',
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACPOR(INDWMUAL)NAME (print) DAVID F. MCKINNON CERTH+ICATION#2411
WELL CONTRACfORCOMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # ( )837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential pf Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water ejection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: AIL&PPi-_County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
960 OGREETA RD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitndcAongitude of well location
3509.262N/8407.658W
3. OWNER: RUSSELL$SUE RHODES (degrees/misi tes/seconds)
Address 16 ELK MOUNTAIN RD Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
/)SMedti.-iL- I NC 28804 DEPTH DRILLING LOG
City or Town State Zip code From To Formation Description
($}$)-254-0460 O'TO 5' BROWN DIRT
Area code-Phone number V TO 20' BLUE GRANITE
4. DATE DRILLED 06/17/2005 20'TO 605' GRANITE
5. TOTAL DEPTH: 605'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 150' Fr.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface' c_
-Top of casing terminated at/or below land surface requim a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 2 METHOD OF TEST AIR ti
10. WATER ZONES (depth): 160', 180,460' 540'
LOCATION SKETCH C7
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the r
Depth Diameter or Weight/Ft. Material numbers and common road names.
From o To 20 Ft. 61/8' - SDR 21 PVC
From To Ft
From To Ft. �6a
13. GROUM 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
Front-To-Ft
From To Ft. (L
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
r rim.,, G _30'-Z6
SIGNATM OF PERSON CON L DATE
Submit the original to the Division of Water Quality,Attn: n agrem�f,161t1� ' Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 d �'�',
� GW-I REV.09/2004
t � _ _J
f\;

V `w
WELL CONSTRUCTION RECORD 3 0
North Carolina Department of Environment and Natural Resources-Division of Water Quality 3 51
WELL CONTRACTOR(INDIVIDUAL)NAME (print) CALVINW.ROSE CERTIFICATION#3327
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): Residential11 Municipal/Public❑ Industrial❑ Agrictilhaal❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: J9^)i,Rew.S County CHEROKEE ❑Ridge ❑Slope )OValley ❑Flat
FAIRHAVEN-END OF PAVEMENT ON RIGHT NEAR POND (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
sVIWICr IQ49'sf"
3. OWNER: WINDELLANDERSON (degre /minutesheconda)
Address 1425 BURNT SCHOOLHOUSE RD Latitude/longitude sourceftiPS❑Topographic map
(Street or Route No.) (cheek box)
J Jg yc ✓iwp NC 28904 DEPTH DRILLING LOG
-city m Town ' state Zip Code From To Formation Description
(8 8 389-8986 V TO 15' DIRT
Area code-Phone number 15'TO 25' BROWN SLATE
4. DATE DRILLED 01/27/2005 25'TO 100' MARBLE
5. TOTAL DEPTH: 400' 100'TO 400' GRANITEIMARBLE
G. DOES WELL REPLACE EXISTING WELL? YES❑ NO I 7. STATIC WATER LEVEL Below Top of Casing: 5 T.
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS 1 FT.Above Land Surface*
*Top casing terminatedal/or below land surface requires• , f
variance in accordance
wiMtM1 i 5A NCAC 2C.01IR
9. YIELD(gpm): 8 METHOD OF TEST AIR
10. WATER ZONES(depth): 66-4 GPM,360'-4 GPM
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Well Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From +1 To 40 Ft. 61W SDR 21 PVC w
From To FL
From To Ft. a
13. GROUT: Depth Material Method �- I✓ ` q
From 0 To 20 Ft. CEMENT GRAVITY \SV
From To FL ,.^ —rim
14. SCREEN: Depth Diameter Slot Size Material Yet ;C
m
From To Ft. ur in. t =a
From To Ft. in. in.
15. SAND/GRAVE!,PACK: ^O m
Depth Size Material C-3�
From To Ft.
From To Ft.
�y _J r.,1sa
16. REMARKS:
n
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION AND RDS,AND TH A COPY OF THIS RECORD HAS BEEN PROVIDED TO I'll,WEL OWNE)j
SIGNATURE OF PERSON CONSTRUCTING TIIE WELT, DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
RaleiPJt,NC 27699-1617, Phone No.[phone],within 30 days.
GWA REV.0912004
MAR - 8 2005

WELL CONSTRUCTION RECORD 3 , 9
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDWIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTH+ICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING$PUMP CO.INC PHONE # 6gpa 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential� Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo raphic/Land setting
Nearest Town: OIL LS County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
LITTLE CHOGA RD. c eck appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: HARRY SWART (degrees/minutes/seconds)
Address 717 EAST OAK ST. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No
(check box)
141SSi mrnEF FL 34744 DEPTH DRILLING LOG
City or Town state Zip Code From TO Formation Description
al( per)-846-4579 0'TO 20' BROWN DIRT SAND
Area code-Phone umber 20'TO 40' TAN/BROWNMHITE DIRT
4. DATE DRILLED 07/21/05 40'TO 80' DIRT/SAND MIXTURE
5. TOTAL DEPTH: 805' 80'TO100' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1 00'TO 117' BLUE GRANITE
7. STATIC WATER LEVEL Below Top of Casing: 100
(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): 5 METHOD OF TEST AIR
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 117 Ft. 61/8' SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Methodca
From_Toap_FL[Prpor•f a tn
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material c�
From TO Ft_ in. in. l t3R
From To Ft. in. in
15. SAND/GRAVEL PACK: u�j
Depth Size Material
From TO Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONS UC
Submit the original to the Division of Water Quality,Attn:Informa i agement,1617 Mail Se enter-
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days
AUG 2 3 2005 V.09/2004
I

WELL CONSTRUCTION RECORD ' ` 9 t �
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC pHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 9 Municipal/Public ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge MSIOpe ❑Valley []Flat
BARNETT RD. (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: DAVID RITZ (degrees/minutes/seconds)
Address 1151 HWY 64 WEST Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Fom]ation Description
361-4500 O'TO 40' RED SANDSTONE
Area code-Phone number 40'TO 80' BLUE SLATE
4. DATE DRILLED 07/18/05 80'TO 705' SLATE
5. TOTAL DEPTH: 705'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1014
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 at/or below land surface requires a r.
variance in accordance with 15A NCAC 2C.0138. l:J S
9. YIELD (gpm): 1 METHOD OF TEST AIR
10. WATER ZONES(depth):— U1
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 10O PPM Show direction and distance in miles from a[ ast
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 80 Ft, 61/8" SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Mat al Method
From 0 To 20 Fr.CEMENT
GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Fmm To Ft. in. in.
From To Ft. in. 111.
15. SAND/GRAVEL PACK:
Depth Size Material
From TO Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDRDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
siuNAwREM PERSON C TE
Submit the original to the Division of Water Quality,Attn: n agemen ,161 N>hfl Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 d
l' AUG 2 3 2005 I GW-1 REV.09/2004

00 E 4 9 7 5
WELL CONSTRUCTION RECORD ll^�
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prhst) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 0 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo hic/Land setting
Nearest Town:�nnQE1.1� Colmty CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
LITTLE CHOGA RD. h ck appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: HARRY SWART (degrees/minutes/seconds)
Address 717 EAST OAK ST. Latitude/longitude source:❑GPSOTopographic map
(Street or Route No.) (checkbox)
Vm 1 mMEt. FL 34744 DEPTH DRILLING LOG
City or Town state Zip Code From TO Formation Description
(�Or7j-846-4579 O'TO 20' WHITE/TAN SANDROCK
Area code.Phone amber 20'TO 40' BLUE GRANITE BOULDER
4. DATE DRILLED 07/23/05 40'TO 60' TAN DIRT
5. TOTAL DEPTH: 406' 60'TO 77' BLUE GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO `1
7. STATIC WATER LEVEL Below Top of Casing: 75 �
(Use"+"if Above Top of Casing) 47
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 cn
10. WATER ZONES(depth): 260 -721
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 11'75pprn Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 75 Ft. 6 1/8- SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From To _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
From To Ft.
Front-To Ft.
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
� e
SIGNA OF PERSO O S U LI I'
ib xi I-
Submit the original to the Division of Water Quality,Attn:Infor 11 Management,1617 4 e Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. I AUG 2 3 2005 '
1 REV.09l2004
�I

WELL CONSTRUCTION RECORD Q
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTORCOMPANY NAME CHEROKEE WELL DRILLING 6 PUMP CO. INC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 01 MunicipaliPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo$$r� aphic/Land setting
Nearest Town: 11)gq,?)LE County CHEROKEE ❑Ridge I4Slope ❑Valley ❑Flat
HWY 141 ( ck appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
I. 5�.U(p? I)J
3. OWNER: DAVID GUFFEY (degrees/r ' tes seconds)
Address 5 WILD BLUEBERRY WAY Latitude/longitude source: pGPS❑Topographic map
(SVeet or Route No.) heck box)
1—fIuRPm NC 28906 DEPTH DRILLING LOG
City of Town State Zip Code From TO Formation Description
8( 28 )-837-7716 0'TO 20' RED/BROWN DIRT
Area code-Phone number 20'TO 80' TAN/BROWN SLATE
4. DATE DRILLED 07/28/05 80'TO117' BLUE SLATE
5. TOTAL DEPTH: 705' 117'TO 705' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 125
(Use"+"if Above Top of Casing) C '^'
8. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated sWor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. -
9. YIELD(gpm): 1/2 METHOD OF TEST AIR coil
10. WATER ZONES(depth):
LOCATION SKETCH p
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thiclmess two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 117 Ft. 6 118" SDR 21 PVC i
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in. y,
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
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
p
RECORD HAS BEEN PROVIDED TO THEE WEL/L�OWNER
SIGNATURE OF PERSON CO UCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn: a�n`pjaOAgeplei t,16d,7 s 11 nice Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 r
GW-1 REV.09/2004
' AUG 2 3 2005 iU

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACIOR(INDIV[DUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # (JiA 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential)4 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring ❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topog hic/Land setting
Nearest Town: fylum�tY County CHEROKEE ❑Ridge ope []Valley ❑Flat
TARHEEL(118 WARREN DRIVE) (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: DOUG&CINDY MULKEY (degrees/minutes/seconds)
Address 6559 OVERLOOK ROAD Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
liME1�11,t I AL 36618 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description ,
)_605-1994 0'TO 20' RED CLAY
Area code-Phone number 20'TO 180' RED SANDSTONE
4. DATE DRILLED 06/30/2005 180'TO 204' BLUE SLATE
5. TOTAL DEPTH: 320' 204'TO 325' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 100 FT.
(Use"+"if Above Top of Casing) :1u,
8. TOP OF CASING IS 1 FT. Above Land Surface*
•Top of casing terminated attor below land surface requires a ,
variance in accordancewith ISA NCAC 2C.0118. a"s
9. YIELD(gpm): 90 METHOD OF TEST AIR
10. WATER ZONES (depth): 240',300',320' Q
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 10O PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From o To Zoo Ft. sva^ 188 GALV.SIt K,*$T
From To Ft. �$ 4s n tE� 0
From TO Ft. ---
13. GROUT: Depth Material Method From 0 To 20 FL CEMENT GRAVITY
From To Ft. G
14. SCREEN: Depth Diameter Slot Size Material `�4
From To Ft. in. in. F
From To Ft. in. in.
15. SAND/GRAVEL PACK: J
Depth Size Material
From To Ft.
From To Ft.
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 PROVIDED TO THE WELL OWNER
o B G-30-0s
SIGNATURE OF PERSON CONSTRUCIFG TI I iE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDrv7DUAL)NAAS (print). WILLIAM BRADLEY LEWIS CERTHRCATION a 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # (d/15)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential In, MunicipattPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water�nlection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge ❑Slope ❑Valley Flat
37 PARSONS PASS (check appropriate box) IN
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
83��/8N/y"SoSbi
3. OWNER: STEVE PARSONS (degrees/mina s/seconds)
Address 37 PARSONS PASS Latitude/longitude sotuce:XGPS❑Topographic map
(Street or Route No.) (c eck box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town state Zip Cole From TO Formation Description
-632-0242 O'TO 10' SAND/CREEK ROCK
Area code-Phone number 1 O'TO 21' BLUE SLATE
4. DATE DRILLED 07/O6/2005 21'TO 205' SLATE
5. TOTAL DEPTH: 205
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 1
7. STATIC WATER LEVEL Below Top of Casing: 20 G
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface* x
-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): LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 10O PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road S.
From 0 To 21 Ft 61/4" .188 STEEL
From To Ft.
13. GROUT: De Ft.
Depth Material Method
From 0 To 20 Ft CEMENT GRAVITY
From To FL 1
14. SCREEN: Depth Diameter Slot Size Material ,U
From To Ft. in. in. $ ,
From To Ft. in. U'
15. SAND/GRAVEL PACK: `r
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND T A C Y OF THIS RECORD S BEEN PRO ED TO THE WELL OWNER
I 7 _� 5
.U✓rj
SIGNATURE OF PERSON CONSTRUCTING L DATE
Submit the original to the Division of Water Quality,Attn:Info6utaflon Management,1617 Maori Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. -----
GW-I REV.09/2004

NC ✓ oiwli MiVD
WELL CONSTRUCTION IM,C01W r' '^ o -a
NotJi Carolina-Dcparlincnl of Enviruwncul and Natural Resources-Division of Water Quality-groundwater Section
WELL CONTIIACIOR(INDIVIDUAL)NAME (prinl)JQ� \1�)S(�ll _ CERIIFICA710N N,IyOU
WELL CONTRACT OR COM PAN V NAME VIA `),Vf AcA) 'sn PIIONE N f?M TSTM2447
STATE WELL CONS FROM JUN PERAII IN ASSOCIATED WQ PERNII'IN
(if npplicnble) (if npplicnhic) _
I. WELL USE(Check Applicnble Ilox): Rcsidcnlinl ❑ MunicipalA'ublic U Indualrinl ❑ Agdcullulai U
Monitoring U Recovery ❑ llcat pump Water Injection ❑ Other❑ If Odier,List Use
2. W ELL LOCATION: Topogrnphie/Lml selling
Nearest TOwir:Al ArD h I Couuly C A� ❑IUdge ❑Slope alley UFlat
&" fk z QA (check apprgpriale bow)
(Suter Name,Number,Cmnmmdry,Subdivision,Lot No.,lip Cute) Laliludeflorgilude of well Iocaliop 4
3. OWNER:�_A I X_ Mu n ndc)
Address 976Z W IZ St Laliludellongiludesource:❑CPS❑Topographiculap
(Street or Route No.) (check boa)
corgl 5p( ingS FL 33D71-582-'t 1xi'-fli VLL1U"-QQ
City or Town State Zip Cmie Floirl To anion Description
f) — .2D.'
Aces code-Phone number aC), qqt)' �r(`[•i Vl`l:D-
4, DATE DRILLED (D-
5. TOTALDEPTII: UQh '
6. DOES WELL REPLACE EXISTING WELL7 YES 11 NO IY
7. STATIC WATER LEVEL DClow Top of Casing: ab FT.
(Use"+•'If Above Top or CailnR)
8. TOT' Of'CASING IS ) I"I•. Above Land Sulfacc•
-Top glossing terminated aagr below land outface requhre a
♦nlsnce In■ecordante with 15A NCAC 1C.01I8. C ..,,
9. YIELD(gpm): (l9 NiETHOU OF TEST s _
10.WATER ZONES(depth): a
LnCAT1014 SKB'fC1(
11. DISINFECTION:Typehwllp�s Amount l5 Show direction and distance in miles from at least
12. CASING: Wnll 1Lickneas two Stale Roads or Co my Roads. Include(())e road:"
Deptli Diameter or weighUFl. Material num mes.
number!and con of oad na i.a
Front C) To , h, 11 _ `-t
From To PI. p, D K b a
Frum To rL
13. GROUT: DepW hiInIletial Mcthod tPy�c
Front_0 To Ft.QnC-tlr.rnA p
From 3r To aC2 Ft. &�AVav6 �,o
14. SCREEN: DepW Die)neler SIOt Size Materiel �f C /L �VV�
Ftonl To Ft.—ill. in. Yi
F 1'o
I5. SANANDlGItAVIiI.PACK: �
DepW Size Mntennl =
Front Tre Ft.
Flom 1'o FL
iveper Pegch I-rQp.' Qdn
16. REMARKS: 1
i DO I IEREUY CERTIFY TI IAT TI IIS WELL WAS CONSTRUg1ED IN-AClV, d14 E ftTtttSRNCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TI TAT A COPY OF T1ll$l)$ C1 iRD�`tA N P%0 1D[�6TQ TI IE WELL OWNER
�yr !it i _. i —
SIGNA1 UItE UI'I'EltSUN CO I l}(JLT%%Fl lggVEM05 �� DATE
Subndt the anginal to(be Ulvfllon of 1Vnler Quallly,Gro I►Jtr (er Section 16 pMdl,�ervic'Center-Ralelgh,NC
27699-1636 rlimie Nu.(919)733-32I1,ivllhln 30 tinys. gn',I" TF SECTI��„_- QW.) REV. 07/2001
ASHFVii I t HN:%IJ�J�� t-rw�

NC ,/- DIfNER -- _-- MII'D —r�_---
OYP
WELL CONSTRUCTION W"X0Rll j
Nor di Carolina-Depar Wlcul of Ltnvirolmteul and Nnluiat Resources-Div ilslon of Water Quality-Groundwater Section
(YELL CONTRACFOR(INOIVIUUAL)NAME (prhm0 � -^ " 'ti7 15nq CERTIFICATION 011& �D
WELLCONi RACFORCOMI'ANYNANIE �IEIIQC \ lm)( CAC 1 92 rlIONE N fur)4b'l-;t2s
STATE WELL CONSTRUCTION rE11A11"TN ASSOCIAI EU WQ 11"111N
� (ifnpllicnblc) (ifnpplicnblc)
1. WELL USE(Check Applicable Dox): Residenlinl IiYMunicipal/Public U Induslriai U Aglicultutal U
Monitoring U Recovery ❑ llcal pump water lujeclion U Other U If Odier,List Use
2. WELL LOCATION- 11 Topogrnphic(Lfmd setting
Nearest Town: Cuunly ❑►Udge OSlope UNillcy UFlal
p ] (check eppeoprinte box)
(SUret sua,N-uf�i,"lobar-e—C—manually,Subdivision.Lot NO..Zip Cale) Lal'luJdlongil JJe of well location
11II ti135`cl '41 '" (NSi�1"
3. OWNER: m'Ky -d� IL" (degreeelnlnutearrecondQ
Address 3 Lathudellougilude source:UGPSOTopoglaphic map
(SUeet a Route No.) (chttk box)
lfuvesvI Ile Nc z vott pet r1t
VOLUNL QU
City o Town Slate zip Cale From , o Formation Dcsciiplion
Arun mJe.rhone number
4. DATE DRILLL'U-�o
5. TOTAL DEPTII:_(oIO'
6. DOES WELL REPLACE EXIS'fINO WELL? YES U NO La-
7. STATIC WATER LEVEL Uciow l'op of Casing: r,ip _FT.
(Uwe"+"if Above"fop of Camp) _
g. TOI' OF CASINO IS 1 1-T.Above Lnnd Sul face* =l
*lop of urlut Iennlneled over below Ind outface requho a C
♦arlxno In accordance with 15A NCAC 2C.0118. arum
9. YIELD(gpm): ME-rllOD OF TESTL
10. WATER ZONES(depth): t OC'AT10N 5KE10I 0
It. DISINFECTION:Typeh��IWLILN Amount t'=t Sllow direction and distance in miles from aTcast "a
12. CASING: Wall Thickness two Slate Roads or County Roads. Include We road?
Depill Dimuctcr o,f�WIeighUFt. Material numbers and conunon toad names.
Fton( n _To_Caf,�:—Ft. A ".,.Z, )1- 1 Tye r75 e
Front To B.-
Front 'To Fl. ow�u
13. GROUT: Depth lalelial Method
From Rl To _Ft. 5
From_-ON'_To 0' FI. s5 �Gfp 00
14. SCREEN: Depth Diameter Slot Size Material
Ftmt% To Ft. in.
From To_FL—in.
15. SANDIOItAVEL PACK:
Drplh Size
From lb FL
From fo F1.
prcr5s�olr^ ��1-
16. REMARKS:
I DO IIEREDY CERTIFY IIIATIIIIS WELL WAS CONSTRUCfED IN ACCORDANCE WITH 15ANCAC 2C,WELL
CONSTRUCTION STANDARDS,AND TIIAT A COPY OF THIS 8 TL1.TIlE WELL OWNER
u
SIGNA'fUllLl OI'PERSON CON INO 771E WELL II J DATE
AUG 9 200? ir �
5ubnlll the arlglual to the Division of\Valor Quality,Cruu dtro er Secllon,1636 Ma 15e enter-Raleigh,NC.
I7699-1636 plwne No. 919 733-3221 w'itlibi 30 dip, GW-1 REV.07/20UI
( ) r ) rR,T IA�II;^-„TF�

WELL CONSTRUCTION RECORD (�
North Carolina Department of Environment and Natural Resources-Division of Water Quality �}^
WELL CONTRACTOR(INDIVIDUAL)NAME (priat) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMTT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: v� Topographic/Land setting
Nearest Town: A049, 3),C— County CHEROKEE IrOt dge ❑Slope ❑Valley ❑F1at
PUETT COVE TO LAUREL DRIVE(ON LEFT) � \ (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3508.21 ON/8354.704W
3. OWNER; JOHN TUCKER (degrees/minutes/seconds)
Address 68 HANNAH LN Latitude/longitude source:❑GPSOTopographic map
(Street or Roote No.)
(check box)
NC 28906
DEPTH DRILLING LOG
cay or own State Zip Code From To Formation Description
8( 28 )-837-9156 0'TO 20' BLACK DIRT
Area code-Phone number 20'TO 80' RED SANDSTONE
4. DATE DRILLED 06/14/2005 80'TO 113' BLUE SLATE
5. TOTAL DEPTH: 805' 113'TO 805' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 91
(Use`4"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface*
•Top or casing terminated at/or below land surface requires a r-
variance in accordance with 15A NCAC 2C.0118. r "!
9. YIELD(gpm): 314 METHOD OF TEST AIR
10. WATER ZONES(depth): BIT SIZE 6.09"
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 ppM Show direction and distance in miles from at lei
12. CASING: Wall Thickness two State Roads or County Roads. Include the triad
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 TO 113 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. a
14. SCREEN; Depth
Diameter Slot Size Material 0
From To Ft. in. in. U
From To Ft. in. in.
15. SAND/GRAVEL PACKI l f/
Depth Size Material �V
From To Ft.
From To Ft. AV'
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A PY OF THIS RECO HAS BEEN P VIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUC LL; DATE
_ ._.
Submit the original to the Division of Water Quality,Attn:Inform AIAlenttgement,1617 Ma0 Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. .
At!' Gw-1 REV.09noo4

1
WELL CONSTRUCTION RECORD 3 1
North Carolina Department of Enviromnem and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADL(l'LEWIS CERTIFICATION 3368
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 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE Ridge ❑Slope ❑Valley ❑Flat
CANEY CREEK RD TO SETTING SUN (check appropriate box)
(Street Name,Numbers,Counounity,Subdivision,Lot No.,Zip Code) LatitudcAongitude of well location
3. OWNER: FREDDIE COOK (degrees/minu[es/seconds)
Address 1161 HWY 64 WEST LatimdeAtingitude source:❑GPSOTopographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town state Zip code From To Formation Description
8( 28 )-360-5542 0'TO 20' RED DIRT
Area code-Phone number 20'TO 80'
SANDSTONE
4. DATE DRILLED 07/14/2005 80'TO 133' BLUE SLATE
5. TOTAL DEPTH: 345' 133'TO 345' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 100
(Use"+-if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface* ��
*Top of casing terminated attor below land surface requires a _
variance in accordance with ISA NCAC 2C.011a.
9. YIELD(gpm): 10 METHOD OF TEST AIR o
10. WATER ZONES(depth): 240'.300',340'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount t00 PPM Show direction and distance in miles from at leas[
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 133 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. 5. ?
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in, in. �j t
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THI O HAS BEEN OVIDED TO THE WELL OWNER
r Lt-L�1.
SIGNATURE OF PERSON CONSTRUC G WELL DATE
Submit the original to the Division of Water Quality,A o ou f� --16an>tgtllteDt,'1 11�ai1 Service Center-
Ra►eigh,NC 27699-1617, Phone No.[phone],within 30 y h V �ti b �'J �-. �j ��1
GW-I REV.09/2004
AUG 1 5 2005 '' I
Irna-+ran cry-rinn

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACfOR(WDIVTUUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
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 g MumcipaUPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injlection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: /)IukP County CHEROKEE ❑Ridge *Slope ❑Valley ❑Flat
HWY 294-IAURELCREST (check appropriate box)
(Street Name,Numbers,Com>mmity,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3. OWNER:7ODD MMRZ'r EN (begreea)airmaea)seccnbs)
Address 728 SEAGATE DR Latitude/longitude source:OGPSOTopogmphic map
(Street or Route No.) (check box)
FL 33602 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
8( 28 )- 361-5274 U TO 20' RED DIRT
Area code.Phone number 20'TO40' SANDSTONE
4. DATE DRILLED 07/12/2005 40'TO 80' BLUE SLATE
5. TOTAL DEPTH: 705' 80'TO 705' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 30 FT. c_ -
(Use-+-if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface* r
•Top of casing termtasted at/or below land surface requiter e
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 113 METHOD OF TEST AIR t
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at leas
12. CASING: Wall gbiclmess two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 80 Ft 6 1/8' SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method g)
From 0 To 20 Ft CEMENT GRAVITY ti,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
Front-TO-FL-in. in. l%
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material wJ L
From To Ft.
m Fro To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WnH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAMACG�FY F THIS REC BEIN PRO ED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING WELL DATE
Submit the original to the Division of Water Quality,Attn: aKon�J ageineht4j 16 7 �ervice Center-
Raleigh,NC 27699-1617, Phone No. [phone],within 30 da u I' I' U S 1
�— 1 i GW-I REV.09/2004
I LI AUG 1 5 -05

WELL CONSTRUCTION RECORD U-^
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (priat) WILLIAM BRADLEY LEWIS CERTIFICATION 113368
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):Residentia Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water/injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE Ridge ❑Slope ❑Valley ❑Flat
HARLEY LN (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: GLENN ROBERTS (degrees/minutes/seconds)
Address 6007 HWY 64 WEST Latitude/longitude source:❑GPS❑TopoglapWc reap
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From TO Fonnation Description
837-5759 0'TO 25' RED DIRT
Area code-Phone number 25'TO40' BROWN SANDSTONE
4. DATE DRILLED 07/12/2005 40'TO 66' GRANITE
5. TOTAL DEPTH: 565' 66'TO 565' GRANITE/SLATE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO g. 1.
7. STATIC WATER LEVEL Below Top of Casing: 140
(Use"+"if Above Top of Casing) G
8. TOP OF CASING IS 1 FT.Above Land Surface'
-Top of easing terminated at/or below land surface requires a 71
variance in accordance with 15A NCAC 2C.0118. -
9. Y UD(gpm): 20 METHOD OF TEST AIR
10. WATER ZONES(depth): 550' En 1
LOCATION SKETCH
It. DISINFECTION:Type CHLORINE Amount too PPM Show direction and distance in miles from at least'
12. CASING: Wall Thictmess two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. �1
From 0 To 66 Ft. 61/8' SDR 21 PVC X
From To Ft. hl A
From To Ft.
13. GROUT: Depth Material Method 5 �L
From 0 To 20 FL CEMENT GRAVITY J
From To Ft.
14. SCREEN: Depth Diameter Slo[Size Material (� V
From To Ft. in. in.
From To Ft. m' - m-
15. SAND/GRAVEL PACK: \
Depth Size Material ��
From To Ft. C
- aDS17t
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NC 2 LL 4 -
CONSTRUCTION STANDARDS,AND THMCYTHIS CORD HAS BEEN P VIDED TO
SIGNATURE OF PERSON CONSTRUCTIlf TIC WELL I)ATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617+!77-71T7,
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. r,
GW-I REV._01M4-_ ---

WELL CONSTRUCTION RECORD C ' 14 4 2
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) JOHN ARTHUR CHASTAIN CERTIFICATION#3401
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):Residentialg Mumcipalftblic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water njection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MutLPM K County CHEROKEE {1(Ridge ❑Slope ❑Valley ❑Flat
MT.PLEASANT RD.TO FRANCIS CIRCLE ' ` (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3500.173N/8412.310W
3. OWNER: LARRY BEAL (degrees/minutes/seconds)
Address 269 GLENN COVE DR Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
D2}.reva r FL 32738 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28 )-644-9365 Y TO 60' RED DIRT
Area code-Phone number 60'TO80' BROWN DIRT
4. DATE DRILLED 07/27/2005 80'TO 120' RED SANDSTONE
5. TOTAL DEPTH: 605' 120'TO 140' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 140'TO 605' GRANITE "
7. STATIC WATER LEVEL Below Top of Casing: 160' r
(Use"+"if Above Top of Casing) e+.
8. TOP OF CASING IS 1 FT.Above Land Surface*
-Top of casing terminated atior below land surface requires a
variance in acwrdame with 15A NCAC 2C.0118.
9. YIELD(gpm): 1 112 METHOD OF TEST AIR cn
10. WATER ZONES (depth): 560' BIT SIZE-6.095 _
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 140 Ft. 61/8- SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 Ft.CEMENT GRAVITY
From To Ft. /s
14. SCREEN: Depth Diameter Slot Size Material
From TO Ft. in. in. F
From To Ft. in. in. -
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft, a i
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 TH17 CORD PROVIDED TO THE WELL OWNER
5
SIG ,,YIM OF PERSON CONSTRLICTING THE WELL DATE
_ --•.---
Submit the original to the Division of Water Quality,Attn:information Management,1611 iF*rvice Ceeter-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days: ---
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD O,�O 3 1 4 4 1 9
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (Print) JOHN ART HUR CHASTAIN CERTIFICATION#3401
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # ('JA 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
EMISSIONS
1. WELL USE(Check Applicable Box):Residential Mumcip"ublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water jection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: AIUQkv County CHEROKEE )Ridge ❑Slope ❑Valley ❑Flat
DICKEY RD TO DAYBREAK IISTATES (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongimde of well location
3. OWNER: LONNIE BALL (degrees/minutes/seconds)
Address 9617 CYPRESS BROOK RO Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
T�npj¢t FL 33647 DEPTH DRILLING LOG
c ty or Town state Zip Cede From To Formation Description
g( 13)-994-9064 0'TO 12' BROWN DIRT
Area code-Phone number 12'TO20' BROWN SANDSTONE
4. DATE DRILLED 07/21/2005 20'TO 40' GRANITE
5. TOTAL DEPTH: 505' 40'TO 505' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 120' FT.
(Use"+"if Above Top of Casing) a e}I
8. TOP OF CASING IS I FT. Above Land Surface* _
-Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 6 METHOD OF TEST AIR
10. WATER ZONES(depth): 220',460' 5.989-BIT SIZE o
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at lea
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. �"^�
From 0 To 40 Ft. 61/8" SDR 21 PVC /L /
From To Ft. ( l7�
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. h' '
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT PY F THIaREC HAS B O ED TO THE WELL OWNER
SIGNA OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:fnformatiou Management,1617 Mail Rtvice Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. - -- !
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD � J H
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) JOHN ARTHUR CHASTAIN CERTIFICATION u 3401
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE 9 ($J$)837-8008
STATE WELL CONSTRUCTION PE.RMPf# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) _
I. WELL USE(Check Applicable Box):Residential MunicipaUPublic ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: /fhuR®H County CHEROKEE ❑Ridge ❑Slope ❑Valley htlat
MARRIES TOP RD (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3500.689N/8414.743W
3. OWNER: MARCIA MORGAN (degrees/minutes/seconds)
Address P.O.BOX 30164 Latitude/longitude source:❑GP$❑Topographic map
(Street or Rome No.) (check box)
G WA(vLAN GA 31410 DEPTH DRILLING LOG
City or Town State zip code From To Formation Description
(�y)_897-2357 0'TO 20' RED DIRT
Area code.Phone number 20'TO60' BROWN DIRT
4. DATE DRILLED 07/25/2005 60'TO 100' RED SANDSTONE
5. TOTAL DEPTH: 405' 100'TO 120' BROWN SANDSTONE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 120'TO 140' GRANITE
7. STATIC WATER LEVEL Below Top of Casing: 75 140'TO 405' GRANITE ?
(Use`•+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface* c -
-Top or casing terminated otter below land surface regaires a _
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 71/2 METHOD OF TEST AIR tv
10.WATER ZONES (depth): LOCATION SKETCH cn
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at le-qt.
12. CASING: Wall Thickness two State Roads or County Roads.Include the iDaQ
Depth Diameter or Weight/Ft. Material numbers and common road eS.
From o To 140 Ft. 61/8" SOR 21 PVC _„�-, 0,,., �'e
From To Ft. �� �� l`Xi�
From To Ft.
13. GROUT: Depth Material Method 7
From 0 To 20 Ft.CEMENT GRAVITY �f
From To Ft. Q
14. SCREEN: Depth Diameter Slot Size Material �Y1
From To Ft. in in. N
From To Ft. in. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To FL W
From To FL
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT COP OF THIS CORDht EEN P OVIDED TO THE WELL OWNER
7 ? —(��
DATE
SIGNA OFPERSO CONSTRUC TIiEWFLL-__..._..___ .__
Submit the original to the Division of Water Quality,Attn:Information Management,1611 mail Sor45g Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. + �
I_I ! AU 2 3 a��5 ���1��1 REV. 09/2004
i

I
WELL CONSTRUCTION RECORD 314417
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (paimt) JOHN ARTHUR CHASTAIN CERTIFICATION#3401
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 0, MunicipaUPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE Midge ❑Slope ❑Valley ❑Flat
CRISP MTN-LOT 27 (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: JAMIE COOK (degrees/minutes/seconds)
Address 71 WILDLIFE HAVEN Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
8( 28 )-360-7500 V TO 60' RED DIRT/CLAY
Area code-Phone number 60'TO120' SANDSTONE
4. DATE DRILLED 07/19/2005 120'TO 140' GRANITE
5. TOTAL DEPTH: 605' 140'TO 605' GRANITE s.Q
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 140
(Use"+"if Above Top of Casing) C
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 1C.0118. N "3
9. YIELD(gpm): 6 METHOD OF TEST AIR '
10.WATER ZONES(depth): 160',540'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at left ,w
12. CASING: Wall Thickness
two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. a 1`�(
From O To 14060 Ft. 6 118" SDR 21 PVC
From To Ft. y
From To Ft. L'
13. GROUT: Depth Material Method Q
From 0 To 20 Ft.CEMENT GRAVITY
From To Ft. (�
14. SCREEN: Depth Diameter Slot Size Material y iY
From To Ft. in. in.
From To Ft. in. in.
�v
15. SAND/GRAVEL PACK:
Depth Size Material
m Fro To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND A C PY OF THIS RECORD ROVIDED TO THE WELL OWNER
SIG6XRM OF PERSON CONSTRU TING WELL 'DATE
Submit the original to the Division of Water Quality,Attn:Information Managgatent,16i7�tl Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days �ug I�
Gw-1 REV.09/2004
i

WELL CONSTRUCTION RECORD GQro 3 1 4 4 9 4
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) JOHN ARTHUR CHASTAIN CERTIFICATION 9 3401
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 Municipal/Public ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: /MARRLE Comity CHEROKEE ❑Ridge F141ope ❑Valley ❑Flat
MARBLE-COALVILLE RD check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3511.722N/8354.611 W
3. OWNER: WILLIA WRENN (degrees/minutes/seconds)
Address 193 MTN VIEW DR Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
k3paQu $ NC 28901 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
(828 )-835-7947 O'TO 20' BROWN DIRT
Area code-Phone number 20'TO 45' BROWN SLATE
4. DATE DRILLED 07/14/05 45'TO 60' SANDSTONE
5. TOTAL DEPTH: 245' 60'TO B6' GRANITE c =<
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 'y�y�l 86 TO 245' GRANITE
7. STATIC WATER LEVEL Below Top of Casing: 50 � —
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface* «�
•Top of casing terminated attor below land surface requires a
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 3 METHOD OF TEST AIR ;
10. WATER ZONES(depth): 220'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 86 Ft, 61/8" SDR 21 PVC
From TO Ft. t"Qgty?lam Q
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FL CONCRETE 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: y�
Depth Size Material
From To Ft.
From To Ft. A112tbwr &NU
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS, T A COPY F S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
ut2 G1/9S A/� 7 /S-�
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD �� v i v
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDWIDUAL)NAME (print) JOHN ARTHUR CHASTAIN CERTIFICATION 93401
WELL CONTRACTORCOMPANY 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 MumcipallPublic❑ Industrial❑ Agricultural❑
El Recovery ❑ Heat Pomp Water nlection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE Ridge ❑Slope ❑Valley ❑Flat
1421 TARHEEL DRIVE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: MARK WEINREICH (degrees/minutes/seconds)
Address P.O.BOX 1118 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
B( 28 )-557-0113 O'TO 40' BROWN DIRT
Area code-Phone number 40'TO 50' RED SANDSTONE
4. DATE DRILLED 07/15/2005 50'TO 65' BROWN DIRT e"
5. TOTAL DEPTH: 505' 65'TO 81' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 81'TO 505' GRANITE r
7. STATIC WATER LEVEL Below Top of Casing: 160' FT. t—
(Use`+"if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface"
-Top of casing terminated attor below land surface requires a
variance In accordance with 15A NCAC 2C.0118. Cn
9. YIELD(gpm): 2 METHOD OF TEST AIR
10. WATER ZONES(depth): 165'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From o To 81 Ft. 61/8- SDR 21 PVC
From To Ft.
From To Ft.
T: I ;Z
13. GROUT Depth Material Method
From 0 To 20 Ft CEMENT GRAVITY
From To Ft. W'
14. SCREEN: Depth Diameter Slot Size Material
From TO Ft in. in.
From To Ft. in, UL
15. SAND/GRAVEL PACK: U
Depth Size Material V � �
From To Ft. 1�
it
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT 1111SWELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELD
CONSTRUCTION STANDARDS, A COPY21_;
RECO B PROVIDED TO THE WELL OWNER
-% 7-19-6
NATURE Of PERSON CON&TRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD lam'" 0 ej 0 3
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) JOHN ARTHUR CHASTAIN CERTIFICATION#3401
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING AND PUMP COMPANY,INC. PHONE # (JA 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential,T( Mumcip la`ublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water''Innjection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: ( County CHEROKEE Ridge ❑Slope []Valley ❑Flat
DICKEY RD TO DAYBREAK STATES (check appropriate box)
(Street Name,Numbers,Community,subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: LONNIE BALL (degrees/minutes/seconds)
Address 9617 CYPRESS BROOK RD Latitude/longitude Source:❑GPS❑Topographic map
(Street or Route No.) (check box)
7- p FL 33647 DEPTH DRILLING LOG
city nr Town state Z,p code From TO Formation Description
994-9064 O'TO 12' BROWN DIRT
Area code-Phone number 12'TO20' BROWN SANDSTONE
4. DATE DRILLED 07/21/2005 20'TO 40' GRANITE
5. TOTAL DEPTH: 505' 40'TO 505' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO k
7. STATIC WATER LEVEL Below Top of Casing: 120' FT. !�
(Use"+^if Above Top of Casing) a-y
8. TOP OF CASING IS 1 FT.Above Land Surface*
•Top of casing terminated atlor below hand warfare requires a
variance in areordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 6 METHOD OF TEST AIR 5.989-BIT SIZE
10. WATER ZONES(depth): 220',460' LOCATION SKETCH
cn
11. DISINFECTION:Type CHLORINE Amoum 100 PPM Show direction and distance in miles from at IQFpt
12. CASING: Wall Thickness two State Roads of County Roads. Include thead
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 40 Ft. 6 1/8" SDR 21 PVC
From To Ft. ES T
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:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT PY F THIS REC HAS B O ID TO THE WELL OWNER
t 1 2-F-©S
SIGNA OAF CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. -
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 5 ® oo
North Carolina Department of Erwironmew and Natural Resources-Division of Water Quality O
WELL CONTRACTOR MgmVmUAL)NAME (print) JOHN ARTHUR CHASTAIN CERTIFICATION#3401
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING$PUMP CO.INC PHONE # (?,V'")837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
000001 (if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Sal MlmicipaltPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Top hic/Land setting
Nearest Town: 1 \( County CHEROKEE ❑Ridge Slope []Valley ❑Flat
KRAMER KNOB LOT#1 ( eck appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: TERRY NEWMAN SR. (degrees/minutes/seconds)
Address PO BOX421553 Latitude/longitude source:❑GPS❑Topographic map
( DEPTH
Street or Route No.)
I S�I IYU'1'�P(' FL 34742 (checkDRILLING LOG
City or Town State Zip Code From TO Formation Description
(La-873-0316 0'TO 20' RED DIRT
Area code-Phone number 20'TO40' BROWN DIRT
4. DATE DRILLED 08/09/05 40'TO 60' GRANITE(SET CASING)
5. TOTAL DEPTH: 405' 60'TO 405' GRANITE
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*
'Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 15 METHOD OF TEST AIR
10.WATER ZONES(depth): 360 380 p
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or weight/Ft. Material numbers and common road names.
From 0' To 6V Ft. 6 118 SDR 21 PVC
From To Ft.
From T( Ft
13. GROUT: Depth Material Method
From 0' To 20' Ft CONCRETE GRAVITY %r.,..
From TO Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft in. in.
From To Ft. in. in. a
15. SANOGRAVEL PACK: j
Depth Size Material \
From Depth
Ft.
From To Ft
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
NA PERSON ON UCTING THE WELL DATE 5
Submit the original to the Division of Water Quality,Ann:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days.
GW-1 REV.09/2004

^10�
WELL CONSTRUCTION RECORD 01
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (psi¢t) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANYNAME CHEROKEE WELL DRILLING$PUMP CO.INC PHONE # [phone]
STATE WELL CONSTRUCTION PERNHT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water nl ction❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE []Ridge 10SIope ❑Valley ❑Flat
GRAPE CREEK TO VICTORY LANE LOT q 6 ( heck appropriate box)
(Street Nave,Numbers,Community,Subdivision,Lot o.,Zip Code) Latitude/longitude of well location
35D'l.PlatoIII Rg"'USt'LV
3. OWNER: ENOCH MARTIN (degrees/minutes/seconds)
Address 3974 HWY 294 Latitudellongitude soulce:OGPS❑Topographic map
(Street or Route No.) (cback box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town state Zip code From TO Formation Description
644-9491 0'TO 20' RED/BROWN DIRT
Area code-Phone number 20'TO30' BLUE GRANITE
4. DATE DRILLED 08/03/05 31'TO 445' GRANITE
5. TOTAL DEPTH: 445'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: too FT.
(Use"+"if Above Top of Casing) A -�
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): 2 METHOD OF TEST AIR v
10. WATER ZONES(depth): 400 CD
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount too PPM Show direction and distance in miles from at least_
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 31 Ft. 6 1/8" SDR 21 PVC
From To Ft.
From To Ft. Sbe
13. GROUT: Depth Material Method
From 0 To 20 Ft CONCRETE GRAVITY j _
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 T
From To Ft.
From To Ft.
J
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUYlNG THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. .
GW-1 REV.09/2004

NB V 01 MER ------- MII'U
Wt,LL CONSTRUCTION RECORD '3 1519 4
Not at Carolina-Depalhucnl orl3nviromueui and Natural Resouices-Division of Water Quality-a[oundwater Section
WELL CON"rRACIOR(INOIVIOUAL)NAME (prhd) JGvv, Q.S p111A)"I �Orl CE1111FICA110NN
WELL CONTRACIOR COa1rAN1'NAMEIMIII�.� 10.011 r�r•�'no, moNE N (62A) 06i_y-2v9y
STATE WELL CONS rRUCIION FEM11TN ASSOCIATED WQ PEPAtl1N
(if npplicnl Ic) (If npplicnlrlc)
1. 1VELL USE (Check Applicnl)le [lux): Itesidcllonl LYMuoicipaUl'ublie U lndualtial U Agilcultuial U
Mulliloling O Recovery L l llcal ruwp Water Ltjeclion U Other O If Outer,List Use
2. WELL LOCATION: Topogmphic/Lnnd setting
Ncolcst l'uwu!M lArbh<r Couuly r ke rn a EIRIdge ClSlope 14"Icy Ul-lal
(d,eck.pp.oprlele box)
(Sueel Nunq Nolnbelt,conunwdly.Subdivision,Lot No.,Vp l:ule) Laliludc/lougilude ofwell lucaiion
3. OWNER:Jn�,n 1��C� aPctc nn (derpeedrnlnnlex/recondc)
Address zr n T .a o <fit i P Ln Lalitudellonghude source:OOPSO fup p oglnphic ou
(Sorel a Iloule No.) (check box) ... ...
Marble Nc 2A905 Ut:11u DIUI-IIMLLOW
City or Town St.le zip Unite From To Commlion Dcsciipliuu
Ito
Airs cede.phone ninnber
4. DATE DRILLED I- '� /�— �t - 85 _ -._. f r
5. l'OTALDEPIII: 95 '
G. DOGS WELL REPLACEEXIS'HNOWELL? YES NO tY
7. STATIC WATER LEVEL Below 7'op of Cnsiug: f.
(Use"f^Ir Above"l np of Co+imp)
B. TOIl OF CASING IS FI'. Above Lnnd Surface• r
-Top of c+,rnp trnnln.red dlnr below imd smr.ce requhri• Q '
•ori.nee In accurdn,tt with llA NCAC IC,01118
9. YIELD(gpnl):�_hIMIOD OF'1'ESl' d"P _ 1
10. WATER ZONES(depth): 1.o A11(ZtJ 5KC1�11
11. DISINFECTION:Type Amount /6 Show ditection and distance lit Iniles floor at lead
12. CASINO: Widi'lllickness two Slate Roads or Coulny Roods.Include We road
Depilt Dialucler or WcighUFl. Material IiulliberN arld coriuriorl toad names.
Fron(_Q_'vQ__K_KL Ill.
From T o 11
Frolm Ton
13. GROUI': Dcpdt Malelial Mediod
I'rortl�_T'o��1°1.��>"t'r�• ur p_ �"4t 1'4r
Frtnn To FI.
14. SCREEN: Depol Diameter Slot Size Maledal
Ftonl To
from To
15. SANDIOR.AVEl, PACK!
Depot Size Material
Flom Tm Fl.
front I'o Fl.
I. REMARKS
1IFREBY CERTIFY TIIAT'IIIIS WELL WAS CONSI'R(ICIED IN ACCORDANCE WITII I5A NCAC 2C,WPLL
RUCTION STANDARDS,AND TIIA'1'A CO►fY OF'I111S RECORD HAS BEEN PROVIDED TU TI IL WELL OWNER
4 lif.���ieAil� _ 17- _?7- b5
SIUNAlU1tL,UI'1'EI(SON CONS II(UCFINU i'llE WELL DAIS
iglnal to the Jilt isloit of 1VMer Qusilly,Groundwri(er Section,1636 Mall Servlce Censer-R1110911,NC
e No.(919)731-32I1,Whhhr 3U daps. (1W-1REV.O7/2UO1

NC ✓ UIVNE)t hllfU
WELL CONSTRUCTION MC0 1 j v
Nof dt Caroliva-Department of Environment and Nalufal Resources-Division Of Water Quality-Uroundwaler Section
�.,,..� � ,�n�Gm r�
WELL CONiMCfOlI(INUIVIUUAL)NANIE (print)
--1. CEnTIFICAI ION N-iyO
!YELL CONTMCfOR WNIfANY NAME �°1((" ' ' '�"�( iIC� `� nv1U r110NE N fR.N1 S"'7' �
STATE WELL CONS I RU(71ION PERAll10 ASSOCIA'IEI)WQ PEMII IN
• (if nl l licnl Ic) _(If applicable)
I. WELL USE (Check Applicable Ilox): ResiJenlinl lI�Munleipal/Public U hnlushial U Aglicullulal U
hiouitoling❑ Recovery U l lent pump Water hljection U Olher U If Others List Use
2. WELL LOCATION: 7bpvgrnphif/Lnn Sinn)
Ncnl sITo,vt:.. Comity
\\ e. ❑Ridge USlope alley ❑flat
(check apryMl ban)
1 atiluJdlOu itude of of well lucnlimr
(Street Neale,Nmnbe_n`,l'onununay,Subdi lalar,Litt No.,Zip Cale) .t�. �y.r W
/� 1
3. OWNER: AA (depeealalnmec/rttnndn)
Address v 76 Z IV W 1 gtk <l reet _ Lolituddlongiludo source:UOPSU"rvpoglill map
(street a Route No.) (check box)
Gorg l Sur FL, 3. 0 7L Z4 pEl'Tll lllt)1 t L+U_I urn
Zlp Cal Front TO F rn iolVc rriptimr
City or Town Stale e (9
(__)
nnre cafe-rbale nam /!Jnber �
4. DATE DRILLED a- 3- O6 154' -- 2r_< '
5. TOTAL DEPTIL•_ Z;2(^S
6. DOES WELL REPLACE EXIS FIND WELL'? YES U NO Un 2
7. Sl-ATIC WATER LEVEL Dclow Top of Casing!-f F.
(Use••a"If Above"Imp of Caning) _
8. TOP OF CASINO IS 1 1•.Allove Lmld Surluce•
'-top or came urinla.lyd aVnr blow land surface reQuh to■ C7
m lance In accordance with 15A NCAC 1C.e11N. ,,1
9. YIEI,D(pin)! )l9 ME1110D OF1ES Al2 Q�
10.WATER ZONES(JcpUl): _ ���ION SKrs(Cj1 0 4
11. DISINFECT ION: Cype Antolini. r Show direction and distance in miles fr01 a476as1
12. CASING:
Wnll'lhickness two Slate Roads or County(toads.Inclu a We road
Depth Uinutcicr or WcighVFl. Material nuulbero and cmmn0u wad names.
FronLQ_To Fl. %— s J aN j pfCKe�
Flout 2/BrJ
• Ffont •1'v Fl.
13. GROUT: Uepdt h alelial Me
ffiod
Flom
Prmr, To FI.
14. SCREEN: Deplll Dimaeter Slot Size MNtelinl
1:1011t To
h1Om - To__Fl. lu, in. l t'cv
15. SANDAMAVI1l,PACK:
Depal Size hlnlerial
rion, rm rl. a 9Y
Flom ry Fl.
16. REMARKS
I Doi it-ItEDY CEItTIFY-II IKr I I IIS WELL WAS CONS 11t11C1"111)IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTItUCT IONS TANDAIWS,AND TI IAX A COPY Op 11119 IU:CORD IIAS BEEN PROVIDED 10 TUE,WELL OWNER
f-S---------------
,�5
�p.v'�
SIUNA'IUIW OF 1'EItSON CONS'I1tUCI-INO 111E WELL UAIE
Subndl the al Ightnl to(he Division of TVnler Qunlhy,Cruundlra(er Sections 163651diService Censer-ItalelQh,NC
17699-I636 rbunc Na.[phone],11II1111130 119y5.
OW-1 REV.07/2UU1

Nc 0IVNE1( ( M11'U
WELL CONSTRUCTION IU,CORD \�� I a 1519 2
Hui al Carolina-Depaltutcut of Hilvitomueul slid Naltual Resoul(cues-Div lslom of Water Quality-Oroundweler Section
\ /,..nn^ 4 R 1 Sn,n CER11FICAT IUN{
21/6
WELL CUNTnAC101((INUIVIUUAL)NAaIE 11,1111011)� "+---'-'
mn \ 11 drM-- ,^of r11UNE N fuel ai Y(-1QG
WELL CUNTnACfOR COMPANY NAME +
ASSUCIA'1'EII WU MAIITM
STATE\YELL CONS fRUCf1UN I'EIUfIT{ (If npplicnblc)
(if nt I lien(le) -
I. WELL USE (Check Applicable [lux): Itesidcsliol Ijk�Munlcipal/Public U ludushial U Agticultutal U
Mutiloriug U Recovery U Ilcal PUMP Willer hticcttom U Other U If Other,List Use
2. \VELLLOCATION: TopogmphiJLalld'ctting
Neatest Town:(Al IF n1 I Couuly C how. UIUJgo USlope Willey Urlat
�'•""f"—r (chmk eppr+pdete box)
uu iluJcofwelllocution
(S eat Nm ae,Nmube,a.Conunun Up
lly,Subdivitla4 Lot No., Colic) LnliluJdl
c) on
3. OWNER: I� Vrrp
n (de{teeelrnlnutea rmond+)
Address S�5 rink Lslilude/loilgilude sourcc:UGPSUTupoglnphic(halo
(check boa)
(St,eet or Route No.) ))Ll'"1'll 1�LL0"QQ
JiArpblz /V hloul To ronllationDcscliplicll
Cityor Town State Zip Cale _ 10+
1---)- _ aus
Alto cede rbone number
4. DATE DRILLED -1- (y' D S 31 —
5. TorALDEPTI1: - ' ---
6. DOES WELL RFPLACE EXISTINO WELL? YES U NO lit
7. SI'AIIC WATER LEVEL Below'I'op of Cnsiugt f5o, —I'1'. r
(Ure'4"If Above lop of Ca+l„a)
8. Tol' OF CASINO IS ) F-I'. Above LnaJ Sullace•
*-top of caging to ndm,trd at/or bduw land go,lace requh to a m 2
♦u l got in■ccor dance with l SA N CAC IC.0 1111.
9. YIELD(@P111): 75+ METHOD OF TEST )Q'F
IU.WATER ZONES (depth): LOCAUQU-SKCNA
It. DISINFECI'IUN:T ,c 10- uo Alultt 1`� Show direction and distance In miles Eom at leas''
yl Wnli lhickness two Slate Road%or County Roads. Include We road
12. CASING: numbers and con ton road names.
Dgnl, 31 Diameter of "e hVl'L MatelI I
trout O To Ft. (0,D ,
rionl s_TO �55 rl. _
Fruit, To Ft.
13. GROUP: DrpJ1 h sletial � McWoJ ell
rfonLia _To
Flout 3' To ao, Ft. QC cct�-
14. SCREEN: Depill Dimueler Slot Size Materiol
Flom To Ft.—Ill. Ill.
morn Tu__FL 111. In.
15. SANWGILAVI?l, PACK:
Depal Size Mnlellal
Flue Ib I t. S ur
Flom 1'0 FL U (-a
16. REMARKS:
1 DO IlrREBY CERTIFY TIIAT'1111S WELL WAS CONS UMC1ED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSI RUCI IONS I'ANDAIWS,AND T11A'r A COPY Or 7,dS RECORD IIAS DUN PROVIDEU TO TIIB WELL OWNER
01
SIONA 1 URB 01• PERSON CUNS'1'ItUCTINO TI IB WELL L
Submit the 01Ighlai to (he Dlvislon of water Quality,Crourfdsvaler Secllunr 1636 M■II Servlce CQIVteerf'�Vgh,NC
77L99-16J6 Phone No.[phone],nilldn 30 days.

NC V NIVNEfI -------- MII'U
------ WELL CONSIR—UC'1.10N 1LLCORtll U"
Nola,Carolina-Depalhncul of L'Rvituuulcut and Nnlutal Resoalces-Uivisloll`of water Quality-UtaunJwater Sccfion,,�1r/
n lA7 JStnn CEIr11FICA7IUNs
WELL CUNTMCIUII(IN UIVIU UAL)NAaIE (PI I119-��( ._„ , R
nn4t_._ 0011 di 'I q
WELL CUNT MCIOR CUa1rANY NAMEjy
ASSOCIA'rEll WQ PERAII I#
STATE WELL CONSTRUC110"VERall" (if p(q.11cnblc)
itn licnlle -
1. WELL USE (Check Applicable Ilun): Itesideulial UliMuuiCipul/Public U h$dmatlial U Agticullulal U
Munilming U Itecovcry IJ lien(1'uwp Water lujecliotl U olher U ifOtller,List Use
2. WELI.LOCA' UN: follogrnphi✓Lund selling
Neatest Tt -)n County S Q'- )t(--" I]Mdge USlupe UVnllcy Uflal
(check aptn"pdeie bne)
--_-- Latitude longitude of well lucation
(Sure) 81, Nmnbri ,Crnumadly,SubJlrl@la4 Lot No.,7,11.Cale) O e �, a �y 2-0
f U. n — (depte✓ndnmr✓$ecm.dr) po—g—rn.phiaulap3. OWNER Lolilude/longucsouC(check box)AJJlcss
-
(Sneer ck Route No) r lL�! l•1N9 i Uct
�ra S .+nx r\ 1/( 2, '&C1 C,
z. Unite 14v,It To �forkuntion1Descli1) iou
City or Town Sule F CAI C- q
s) op 11,0 _
Aire tale-rhnne niunbcc — r c h ' P
4, DAT'E DRILLED 'Y-c� o Q'b Qt7
5. Tot-ALDEPTIL�?�S '
G. DOES WELL 11PPLACE EXISTING WELL7 YES U NO LI- a. n
7. S7'AT'IC WKI-EIt LEVEL Uclow Top of Cnsiug: t-1S -i T. c
(Ure"4-If Abnvr'l op of Cminp) ^
8. TOP Op CASINO IS_1____1 f.Abuve Lond Stu race*
-Top of c.d.{Irnaleebd error W1,land$ortece require$a
♦ntance in accordant@ nllh ISA NCAC IC.0116 C)
s. YIELD (gpm):�_MEruou of rl T� 2
10.WATER ZONES OWN: j,QCO'(ION 5 iLm1
e S ul SS Show ditection slid distance in miles Gan at lead
11. DISINfECI'ION:Type AuwuWnll'111ickness two slate Roads or County Roads. htclude We road
12. CASING: Rumbers and clnlullou toad nanc�.
Vepth Diouletcr OFWcighVl:L Malell-alDll e,aa
'
Etmll—�_To t I:t. �2 L7
Eroul To H.
w.%soh
Flom Tm Pt. J�r�
13. URUUT: Depal Ni IcIlal �M�calod
front (7 TO l'1. � a perLM� — r7
hom—�._To_�C - Pt. 6ea)12st
14. SCREEN: Depth Diameter Slot Size Malednl
front Tv 19. iR. In.
from Tu__El. lu, in.
15. SANUIURAVEI.PACK:
Depill Size Mnlalnlso y
r
Etum I'll IT ��
front Fit 11 3resvlow-
16. REMARKS:
I DO IIL•ItEDY CEItMY TIIAT'I111S WELL WAS CONS'l RUCiLD IN ACCORDANCE WITH ISA NCAC 2C,WI!LL
CONS(RUCfIONSTANDA►tDS,ANDTIIAT'A COPY Mills RLCORDIIAS BEEN PROVIDEUTOT11EWELLOWNER
� �2 &5 —
SIONATUItE 01:PERSON CONS"rRUCrINU TILE WELL VATL'
Submit the orlghlal to the Div Ili"of 1Valer gItnlllye Groulld(raler section,1636 Moll Service CaW l RAIdgU7 NUUI
T7699-1616 fhvuc Nu.(9l9)7JJ-J221,vtitl(bt JU day{.

NC 1)IVNE(1 mil'N
WELL CONSTRUCTION IM"CORU M— 3 1 5 1-8 6
Not a]Carolina-Dept intent of Lruvirutuucul and Nolutal Resoulces-D{visluu of Water Quality-Utoundwalcr Section, !,
IVELLCONLRACIUII(INUIVIU ��`^'
UAL)NAPIE (tn hd) t o P'. 1-w7��SAn' CERTIFICA7 IUN N,�/^7
WELL CONTRACFUR COa1PANY NAME M�I IN 11 1.620 Af ,r15 PIION6 / (k ) 5-r��1-.244'?'..,.
STATE IVELL CONSTRUCt1UN PERAIII'M ASSOCIA7"En WQ PF.Ratlia
(ifnpplicnblc) (Ifnppllcnblc) - r--� i
I. WELL USE (Cluck Applicable Ilan): Resideuliul IX/Muulcipal/Public U Indualliat U Agr{cultulal U
Muuiloting❑ Recovery U Ileat 1'uwp Witter hljeclion U Other U If Oilier,List Use
2. WELL LOCATION: Topogrnphi✓LRnd selling Neatest Town: ftah4Couuly UWdge 155rope UVnllcy UFlal
�a (clink appi opdnte ban)
(�� _—_
rr c '—T—�`— Lati d I n�ilude of well local' n
(Surer N•me,Nuntbeu,t'ouununpy,Subdirlslat,l,ol No.,7,(p Cale) �u
0-00 4 g WBy�57a-H
J. OWNER: (dealres/ndnuter ae<nnd.)
Address 150q HPtlf ' Lnliluddlougiludesouree:UUPsorupogtnpbicnlap
(Stint a Route No.) (clink bon)
M u r A r ' VMUJ—Wm I1QU
Clty or Town Stsle Zlp Cale Floln TO •oRmhon Dcselipliuu
/ors cede-rbmm ninnbcr
4. DATE DRILLED 6- O,;L 7 S
5. TOTAL DL'1'TII: /n_C '
6. DOES WELL REPLACE ERISTINO WELL) YES U 140 L7 ;1
7. STATIC WATER LEVEL Ucluw'rup Of Cnsiug:—r•'Q__I'r. f i
(Use-+-If Above'1 np or Cn.lna) �"•
8. 1'0I' OF CASINO IS_�___1"1'. Above Lnud Sutl'uceo r
.lop of odnr Is,... Ird aVor brlow land sml.ce segnl,Is a G
♦all.nre In anordolae wllb ISA NCAC 1C.0116. e
9. YIELD(gpnl): .SO METHODOFTESf� D a'
IU.WATER ZONES(depth): ems—F'—
_ LQCAII.QLSK_LLC11 u'
11. DISINI'CCf10N:'fype o Anwuul IS Show direction and distance In miles fluid at 16
12. CASING: Wall'lllickoess two Slate Roads or Cowdy Roads. 6rclude tile road
Depth Dinulelcr Or Weight/Ft. Malctlal Rumbera and cmltmon roa lames. /zoar e-
Ftunl[_1b Y4 Ft. (R,95 �C�L �_
rrou, To FC &100 •
Flom To—rl.
13. 0ROUI': Dq,lh Mnicr al Methud
rton, 0 're 'rL Dac
Froth To IT If
14. SCREEN: Depth Dituneler Slut Size Malerlid
glom TO rl, in. In.
Trout Tu Ft. lit. In.
15. SANINGRAVEL PACK: yrtnrPes-
Delius Sin Mnlnlnl _� %Op,Qj
F10111 rn Fl.
rtum r1, Ft.
16. REhIAI?KS:
I DO HEREBY cut rlr•YTIIAT'fl[IS WELL WAS CONS]RUCfpD IN ACCORDANCE WITH I5ANCAC 2C,WELI.
CONSIRUC-HON STANDAIU)S,AND TIIAI'A COPY Ur'1111S IUICORD IIAS BEEN PROVIDED TO TIW WELL OWIIER
X-- -2 os
SIUNAIUIIE Ur I'EI(SUN CONS'I'RUCHNU 111R WELL DATE
Subudi the orlglRal to the DIVI11011 of Water Qunllly,Groundwater Section,1636 MailServlce Cenler•Italcigh,NC
17699-IW6 Phmle No.[phone],1VIIIII11 JU 11nys, OW-I RLIV. 07/20U1

I
WELL CONSTRUCTION RECORD GYQ) j ,, u €� 1
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLL4M BRADLEY LEWIS CERTIFICATION#3388
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC PHONE # d�N_837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
Mongolians
1. WELL USE(Check Applicable Box):Residential t Mumcipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water�Jection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo raphic/Land setting
Nearest Town: f� r�QCounty CHEROKEE ❑Ridge It
❑Valley ❑Flat
HWY Y94 ( heck appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitudellongitude of well location
3. OWNER: JEFF&LAURA HUTT (degrees/minutes/seconds)
Address 330 63rd CT. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (ebeck box)
f(1j10.A o1.1 FL 33050 DEPTH DRILLING LOG
City or Town state Zip code From To Formation Description
(%5-743-2560 0'TO 20' RED DIRT
Area code-Phoneamnber 20'TO40' DARK BROWN DIRT
4. DATE DRILLED 08/02/05 40'TO 60' GRANITE _
5. TOTAL DEPTH: 305' 61 TO 305' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO ❑
7. STATIC WATER LEVEL Below Top of Casing: 125' FT. s
(Use`+"if Above Top of Casing) r:.1
8. TOP OF CASING IS 1' FT.Above Land Surface*
`Top of casing terminated Wor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. n �,
9. YIELD(gpm): 30 METHOD OF TEST AIR _
t.e
10. WATER ZONES(depth): 180
LOCATION SKETCH o i;
It. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles fror`irk leasx
12. CASING: Wall Thickness two State Roads or County Roads. Include the roail
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0 To 61 Ft. 6 1/8 SDR 21 Pvc
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0 To 20 FL CEMENT GRAVITY \'
From To Ft.
14. SCREEN: Depth Diameter S1otSize Material
From To Ft. in. in.
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material _
From To Ft.
From To FL 1.
16. REMARKS:
I DO IIEREBY 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
�h/a /i � t&a6c&V tk).1105-lo
SIGNATURE OF PERSON COOSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days. -
GW-1 RE11.09/2004

WELL CONSTRUCTION RECORD � ,(((�►►► f/� r
North Carolina Department of Environment and Natural Resources-Division o aim ter Quality l c
WELL CONTRACTOR(INDWIDUAL)NAME (prtat) IOHN ARTHUR CHASTAIN CERTIFICATION#3401
WELL CONTRAcroRcoMpANy NAME CHEROKEE WELL DRILLING$PUMP CO INC
PHONE # ( _D 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential f� Municipal/Public
Monitoring❑ Recovery ❑ Heat Pump WaterZtn1jection❑�Othe 0 I Other, ❑e Agricultural❑
2. WELL LOCATI N:
Nearest Town: ulf County CHEROKEE Topographic/Land setting
VALLEY RIVER MTh.SENIC HIGHLANDS edge []Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER: BILL MOSER
Address 3210 BENT PINE DR. (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
�f
(Street or Rome N 3 (check box)FL 4951 DEPTH DRILLING LOG
Cny or Town state zip code From To
579-6165 Formation Description
Area code-Phone number 0'TO 10, RED DIRT/SLATE ROCK
4. DATE DRILLED08/11/05 10'TO80 BROWN DIRT `-
5. TOTAL DEPTH: 305' 80'TO 100' GRANITE/SE$CASING
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 1 00'TO 305' GRANITE
7. STATIC WATER LEVEL Below Top of Casing: So' F rQ
(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 requim a CII
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 20 METHOD OF TEST AIR =�
10. WATER ZONES(depth): 220' BIT SIZE 6.098"
260' LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100PPM Show direction and distance in Trines from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 100' Ft. 6 1/8 SDR 21 PVC ---_
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' FL CONCRETE GRAVITY
From To FL
14. SCREEN: Depth Diameter Slot Size J
Material
From To Ft
From— in.
To in,
Ft. in.
n.
15. SAND/GRAVEL PACK:From R I
Depth Size Material
To Ft. ,
From To Ft. �a � ��
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND
fT�HAT AA COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
opp
SIGNAT[IItE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACeOR(iNinvIDuAL)NAME Umint) WILLIAM BRADLEY LEWIS
CERTIFICATION#3368
WELL CONTRACTOR coMPANV NAME CHEROKEE WELL DRILLING 8 PUMP CO.INC
PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT#(if applicable) MI ASSOCIATED WQ PERT#
(if applicable)
I. WELL USE(Check Applicable Box):Residential I�I Munici
Monitoring❑ Recovery ❑ Heat Pump Water njection❑p Otherr❑ IfOther st❑ Agricultural❑
Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE Topographic/Land settin
LANCE RD. ❑Ridge ❑Slope El
LANCE
(Street Name,Numbers,Co__,y,Subdivisioq Lot No.,Zip Code) (check appropriate box)
Latitude/longitude of well location
3. OWNER; DALE WITTING 3500.379N 8404.612W
Address 119 MIMOSA LANE (degrees/min s,/seconds)
Laritude/longimde source: GPS❑Topographic map
(Street or Route No.) check box)
MURPHY NC 28906 0'TO 20'DEPTH DRILLING LOG
8
city or Town sate Zip code From To Formation Description
Areaa c code-Phone n-837-9199 umber RED SLATE
4. DATE DRILLED 08/10/o5 20'TO 40' SOFT BROWN SLATE
5. TOTAL DEPTH: 305' 40'TO100' WHITE SAND SLATE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 100'TO 121' HARD BLUE SLATE
7. STATIC WATER LEVEL Below Top of Casing; 150' Ill ' T� �,r')c
(Use`+"if Above Tap of Casing) �;`--
8. TOP OF CASING IS 1' FT. Above Land Surface' a
`Top of easing terminated at/or below land surface requires a
variance in accordance with ISA NCAC 2C.0118. N ;,
9. YIELD(gpm): 30 METHOD OF TEST AIR
10. WATER ZONES(depth): 200' o
280' LOCATION SKETCH �,
11. DISINFECTION:Type CHLORINE Amount 100PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the'kbad
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 121' Ft. 6 1/8 SDR 21 PVC
From To Ft.
From To FL �
13. GROUT: Depth Material Method
From 0' To 20' Ft.CONCRETE 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:
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
n
7 G}i
SIGNATURE OF PERSON CO U TING ThE WELL LATE
Submit the original to the Division of Water Quality,Attu;Wormadon Management,1617 Mail Service Center-
Raleigh,
NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

I
WELL CONSTRUCTION RECORD QAW e v
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (PA,,) WILLIAM BRADLEY LEWIS
CERTIFICATION it 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING 8 PUMP CO.INC PHONE # (a28)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
000100 (if applicable)
(if applicable)
I. WELL USE(Check Applicable Box):Residential k Municipal/Public
Monitoring❑ Recovery ❑ Heat Other1 ❑ Industrial❑ Agricultural❑
Pump Water Infection❑ Other❑ If ether,List Use
2. WELL LOCATION:
Nearest Town: MURPHY County CHEROKEE Topographic/Land setting
LANCE RD, SUGAR MAPLE ❑Ridge &510pe ❑Valley ❑Flat
(Street Name,Numbers,CommuniTy,Subdivisioq Lot No.,Zip Code) (check appropriate box)
Latitude/longimde of well location
3. OWNER; DALE WITTING 3500.465N 8404.284W
Address 119 MIMOSA LANE (deg me/""" tgggs/seconds)
(Street or Route No J
LatimdeAongitude source GPS❑Topographic map
(MURPHY NC 28906 heck box)
DEPTH DRILLING LOG
From TO
City or Town State Zip Code F
837-9199 Formation Description
Areamc[J- honenumber O'TO20' RED/BROWN DIRT
4. DATE DRILLED 08/09/05 20'TO 40' SLATE/TAN SLATE
5. TOTAL DEPTH: 805, 40'TO 100' BROWN/TAN SLATE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 100'TO 805' BLUE SLATE
7. STATIC WATER LEVEL Below Top of Casing: 100' IT
(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. N
9. YIELD(gem): 7 METHOD OF TEST AIR
10. WATER ZONES(depth):
0
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100PPM Show direction and distance in miles from at least
12. CASING: Wdl Tluclmess two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 138' Ft. 6 118 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' FL CONCRETE GRAVITY ( "
From To FL
14, SCREEN: Depth To Diameter Slot Size Material
From Ft. in. in. 0,
From To Ft. in. in. ���l
15. SAND/GRAVEL PACK: Q6,,
Depth Size Material
From To Ft. L7
From To Ft
16. RE14ARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WE4
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO nm WELL OWNER
SIGNATURE O PERSON C-UNSTRUCTING THE WELL DATE
Subunit the original to the Division of Wad Quality,Attu:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV. 09/2004

WELL CONSTRUCTION RECORD 315452
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prlmt) WILLIAM BRADLEY LEWIS CERTIFICATION p3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING 8 PUMP CO.INC. PHONE H [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMTTii
(if applicable) if applicable)
1. WELL USE(Check Applicable Box):Residential( Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water n ection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:ANDREWS County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
HEALEY FIELDS check appropriate box)
(Street Name,Numbers,community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: DICK RIDDLEBARGER (degrees/minutes/seconds)
Address PO BOX 1280 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
ANDREWS NC 28901 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
8( 28 ).321-2191 O'TO10' RED DIRT
Area code-Phone number 10'TO 24' BLUE GRANITE
4. DATE DRILLED 08/11/05 24'TO 105' GRANITE
5. TOTAL DEPTH: 105'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO r
7. STATIC WATER LEVEL Below Top of Casing: 40' G-I
(Use"+"if Above Top of Casing) C�
8. TOP OF CASING IS 4' FT.Above Land Surface*
'Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.Oil& r rr
9. YIELD(gpm): 30 METHOD OF TEST AIR =
10. WATER ZONES(depth): 80'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thiclmess two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road S.
From 0' To of Ft 6 1/8 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' Ft CONCRETE 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: rDn�! C1
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
T,UR E'ER 'I J PING
SIGNA OF CONS C THE WELL DATE/I
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. - L
GW-1 REV.09/2W4

WELL CONSTRUCTION RECORD 15 4 u
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELLCONTRACTOR(INDIvmUAL)NAM6 (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACrOR COMPANY NAME CHEROKEE WELL DRILLING 8 PUMP CO.INC PnoNE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential Mumcip"Tic❑ Indus nal❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: i r ug,9 M County CHEROKEE ❑Ridge ❑Slope ❑Valley )(Flat
PUETT COVE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No,Zip Code) Latitude/longitude of well location
3508.328N 8355.149W
3. OWNER: JULIE ROBEY (degrees/�''lates/seconds)
Address 15230 HWY.515 SOUTH Latitude/longitude source:nee
map
(Street or Route No.) ( heck box)
FLLIM GA 30536 DEPTH DRILLING LOG
city o Town State Zip code From To Formation Description
8( 28 )_ 361-6365 U TO 40' BROWNITAN SLATE
Area code..Phone number 40'TO 83' BLUE SLATE -
4. DATE DRILLED 07/28/05 83 m LUIS' p ut E SLATF.
5. TOTAL DEPTI4: 405'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO c
7. STATIC WATER LEVEL Below Top of Casing: 25'
n�
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS 1' FT.Above Land Surface*
*Top of casing terminated aHor below land surface requires a
variance inacmrdaace with 15A NCAC 2C.0318. CJ7
9. YIELD(gpm): 1 1/2 METHOD OF TEST AIR
10. WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 10OPPM Show direction and distance in miles from at least
12. CASING: Wall Thiclatess two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 83' Ft. 6 1/8 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 29 Ft.CONCRETE GRAVITY D
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in in Q My15. SAND/GRAVEL PACK: }Wy cj
Depth Size Material
From-To Ft.
From To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PEP SO NS UCTING THE WELL DATEl
Submit the original to the Division of Water Quality,Attn:Information Managtmlent,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. C I i
GW-1 REV.09/2004
i

WELL CONSTRUCTION RECORD
9A 31_ 54
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACfORCOAIPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential MunicipaliPublic❑ Industrial❑ Agricultm al❑
Monitoring❑ Recovery ❑ Heat Pump Water In ection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo raphic/Land setting
Nearest Town:ANDREWS County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
HEALEY FIELDS (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3512.319 N 8353.146W
3. OWNER: ROY SARGENT (degrees/miseconda)
Address PO BOX 1149 Latitude/longitude source:RIGPS❑Topographic map
(Street or Rome No.) heck box)
ANDREWS NC 28901 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
8( 28 )-321-4442 O'TO 20' RED&BROWN DIRT
Area code-Phone number 20'TO40' BROWN DIRT SAND
4. DATE DRILLED 08/11/05 40'TO 60' BROWN DIRT SAND&GRANITE
5. TOTAL DEPTH: 405' 60'TO 86' SOFT BLUE GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 86'TO 405' GRANITE _
7. STATIC WATER LEVEL Below Top of Casing: 80'
(Use^+"if Above Top of Casing) _
8. TOP OF CASING IS 6' FT.Above Land Surface* C=
•Top of casing terminated at/or below land surface requires a pavariance in in accordance with 15A NCAC 2C.0115. W -1
9. YIELD(gpm): 2 METHOD OF TEST AIR e
10.WATER ZONES(depth): BETWEEN 200'&300' 1112
BETWEEN 300'&400'1/2 LOCATION SKETCH -
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To W Ft. 61/8 SDR21 PVC
From To Ft.
From To Ft. �
13. GROUT: Depth Material Method
From 0' To 20' Ft CONCRETE GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in in.
From To—FL—mi . in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. -
16. REMARKS:
i .
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 BE
13K PROVIDED TO THE WEL OWNER j
,-C ,
SIGNATURE OF P CO TRUC WELL A -'
Submit the original to the Division of Water Quality,Attu:Information Management,1617 Muff Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. -
GW-1 REV.09604

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) JOHN ARTHUR CHASTAIN ��'' CERTIFICATION#3401
WELL CONTRACTOR COMPANY NAME Pt4Ir Q1�1(E 11JEt.L �1LLJA4 s IW1eG_LA.1tPHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential MunicipaW&IiC❑ Industrial❑ Agricultural❑
Monitoring❑ 'Recovery ❑ Heat Pump Water ection❑ Other❑ If Other,List Use
2. WELL LOCATION: Top° raphic/Land setting
Nearest Town: �UrPl1V County CHEROKEE ❑Ridge gpSlope ❑Valley ❑Flat
ED GRAVES RD. ( ck appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: DANIEL MILLER (degrees/minutes/seconds)
Address 1843 DAYLILY DRIVE Latitude longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
i gRp�L- NC 28905 DEPTH DRILLING LOG
��ry or Town state Zip Code From To Formation Description
8( 28 )- 837-3422 U TO 18' BROWN DIRT&GRAVEL
Area code-Phone number 18'TO 40' GRANITE/SET CAS1/t1G
4. DATE DRILLED 08/10/05 40'TO 305' GRANITE
5. TOTAL DEPTH: 305' a•
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO G—)
7. STATIC WATER LEVEL Below Top of Casing: 50 ry
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface" o
'Top of casing terminated st/or below land surface requires a
variance in accordancewith 15A NCAC 2C.0118.
9. YIELD(gpm): 30 METHOD OF TEST AIR
10. WATER ZONES(depth): 80%200%240%260'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 40' Ft. 6 118 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' Ft.CONCRETE GRAVITY
From To Ft. L D
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. irL
15. SAND/GRAVEL PACK: �)
Depth Size Material
From To Ft.
From To FL
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OFF1 THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SI(I3/ TURE OF PERSON CONSTRUCTING Tilt WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.0912004

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality c1 15448
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIEFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential1 Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water n ection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge PtSlope ❑Valley ❑Flat
BOBCAT LANE heck appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: JEFF KEEN (degrees/minutes/seconds)
Address 78 ALMOSTA RD. Latitudeilongitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
8( 28 )-361-6975 O'TO 20' WHITE SAND ROCK
Area code-Phone number 20'TO 40' WHITE SAND/BROWN DIRT
4. DATE DRILLED 08/15/05 40'TO 60' BROWN DIRT/GRANITE
5. TOTAL DEPTH: 505' 60'TO 505' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO yy�
7. STATIC WATER LEVEL Below Top of Casing: 100'
(Use"+"if Above Top of Casing) -•
8. TOP OF CASING IS 1' FT. Above Land Surface* N
-Top of casing terminated at/or below land surface requires a W .a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 10 METHOD OF TEST AIR
10. WATER ZONES(depth): 500'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To W Ft. 61/8 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' Ft.CONCRETE GRAVITY t L Lr .
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
�l
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material yCi
From To Ft. —�
From To Ft.
16, REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDf//AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
, c
dr2 y' In
SIGNATURE OF—PERSON CONYRIXTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 0-R-0 , A r
7
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) Mn applicable)
1. WELL USE(Check Applicable Box):ResidentiaMurdcipaltPublic ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water nlection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
NearestTowm MiOZPl-ty County CHEROKEE I
Ridge ❑Slope ❑Valley ❑Flat
MCCLURE RD TO 15 CHARLEY LN (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3503.165N/8403.869W
3. OWNER: CARL&CLEO SMITH (degrees/minutes/seconds)
Address 425 GROVE RIDGE DR Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
�.f+4aJ✓r/rF. GA 30052 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
8( 28 )-837-8344 0'TO 60' RED SANDSTONE
Area code-Phone camber 60'TO 80' BROWN SANDSTONE
4, DATE DRILLED 08/05/05 80'YO 95' BLUE SLATE
5. TOTAL DEPTH: 505' 95'TO 505' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 100
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface* a�
'Top of casing terminated attor below land surface requires a
variance in accordance with 15A NCAC 2C.0118. r'„ .71
9. YIELD(gpm): 2 METHOD OF TEST AIR 72
10. WATER ZONES(depth): 200' cn
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names. /
From 0' To 95' Ft. 61/8- SDR21 PVC
From To Ft. LCl ui2�
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' Ft CONCRETE GRAVITY
From To Ft. Z
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in
From To Ft. in. Hit.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
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 S BEEN VIDED TO THE WELL OWNER
ltf2
SIGNATURE OF PERSON CONSTRUC TI-IE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days. - ----
GW-I REV.09/20M

WELL CONSTRUCTION RECORD 0-0 3 1 44 6
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDWIDUAL)NAME (Print) WILLIAM BRADLEY LEWIS CERTIFICATION M 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC PHONE M [phone]
STATE WELL CONSTRUCTION PERMTTN ASSOCIATED WQ PERMIT#
(if applicable) (if applicable) _
1. WELL USE(Check Applicable Box):Residential MunicipaVPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water ltection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land settinH�(
Nearest Town: MURPHY County CHEROKEE ❑Ridge ❑Slope ❑Valley yNFla[
15600 JOE BROWN HWY. (check appropriate box) /
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3511.771N 8408.917W
3. OWNER: DAVID MOON (degrees/minutes/seconds)
Address 15600 JOE BROWN HWY. Latitnde/longitude source:) GPS❑Topographic map
(Street or Rome No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
�C^C`ity or Town state Zip Code From To Formation Description
ck . - sfsI's(e I 0'TO 20' RED/BLACK DIRT
Area code-Phone number 20'TO 30' BROWN SLATE
4. DATE DRILLED 08/16/2005 30'TO 40' BLUE SLATE
5. TOTAL DEPTH: 125' 40'TO 125' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50
(Use"+"if Above Top of Casing) ?�
8. TOP OF CASING IS 1 FT.Above Land Surface*
-Top of casing terminated at/or belay land surface require%a
variance in accordance with 15A NCAC 2C.0118. tV ;
9. YIELD(gpm): 30 METHOD OF TEST AIR BIT SIZE 6.056 o w
10. WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thick❑ess two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 40' Ft. 6 118 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 29 Ft CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. io in
15. SAND/GRAVEL PACK:
Depth Size Material -
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT TT-HS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A PY OF THIS RECO HAS BEEN PROVIDED TO THE WELL OWNER
IGNA�PEPSO C� C WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 011-0 31 I
North Carolina Department of Environment and Natural Resources-Division of Water Quality 5 4 6 5
WELL CONTRACTOR(INDIVIDUAL)NAME (print) JOHN ARTHUR CHASTAIN CERTIFICATION p 3401
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING 8 PUMP CO INC PHONE tt (RIR)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
MEME (if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential MunicipaUPubhc❑ Industrial❑ Agficul(uraj❑
Monitoring❑ Recovery ❑ Heat Pump Water ection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
LOWER BEAR PAW D. heck appropriate box)
(Street Name,Numbers,Community,subdivision,Lot No,Zip Code) Latitude/longitude of well location
3. OWNER: PAULA DOSS 3507.048N 8411A78W
. (degees/miqutes/seconds)Address 3910 Latitude/longitude
source: GPS❑Topographic map
(Street or Route No.)
Erl J'IV r cl FL 33901 D ( eck box)
M
DRILLING LOG
City dr Town State Zip Code From TO Formation Description
(a39)-277-0314 0'TO 20' BROWN DIRT
Area code-Phone number 20'TO 40'
4. DATE DRILLED 08/17/05 RED DIRT
5. TOTAL DEPTH: 105' 40'TO 60' GRANITE SET CASING
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 60 TO 105' GRANITE
7. STATIC WATER LEVEL Below Top of Casing: 25
(Use"+"if Above Top of Casing) e 4
8. TOP OF CASING IS 1 FT. Above Land Surface*
-Top of casing terminated at/or below land surface requires a C
variance in accordance with 15A NCAC 2C.0118. -
9. YIELD(gpm): 50 METHOD OF TEST AIR w
10. WATER ZONES(depth): 70' c
LOCATION SKETCH cn
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 60' Ft. 6 1/8 SDR 21 PVC
From To Ft.
Fmm To Ft.
13. GROUT: Depth Material Method
From 0' To 60' Ft.CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material --
From To Ft. in. in. E
From To Ft. in- in L
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. J T
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 THIS WELL OWNER
y
SIGNA OF PERSON CONSTRUCTING THE WELL D TE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center- _
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV_09/2004 _

WELL CONSTRUCTION RECORD
North Carolina-Department of Gol*oammt and Nal m l Resources-Division of Wales Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (vrtao _WAUD R O
CERTIFICATION A,�
'a>:LL rnNTRAcroxco tnrANYNAatE.Bo.�!5 WP 1I f.�r i tI i � PRONE a
SrATE WELLCORSTIIWMK PERbUy4 A45pClATEU WQ wQ pEQMRIe /
Ctfappiiabk) (ifaFd
1. WELL USE(C lode Applieable Box):Residential O Mw icipalWabiic D Industrial❑
Mmutorml;D Recovery ❑ Heat Water Agtiwittaa!D
Puntp Ittjextias D Other D If Other,List Use
2. WELL LOCATION.
Nearest Town: 4,C County- voke. TOPo6MphidLandsett)
Yt Q' P'O Oir.m4 I%-f DRielge DSlope DValley iiYAr-fat
tseea N■aCi LCmeeual.SubNvteiae.TM Na,Zq.Code) (nongatdeof well
1, 1-atiluddloogitudc of welt location
3. OWNER: ►a-W /n_C
Address �_. l2 t-3 6A (dgp�/mirnae4seowWg
ff &cctorttoeuNay Latitu"ongtludesourm13GPSDTOpoptap%,map
T I\C O Y 11�t o l 1-1-3 3 7 S S DEUH (dieck box)
DRILLING LOf
GquTown .■e Z+F Code From TO
Arco eerie.Pl■re.wahc n �J Formation Deatl54 rfa A ..)
4. DATE DRILLED -
5. TOTAL DEPTH:_ f u 5
6. DOES WELL REPLACE FMSTING WELL? YES O NO
7. STATIC WATERL.EVELBelowTopofCasing:
S. TOP OF CASING IS ).E5 �F
' FT
AAboev e and Surfyaaec)`
Top afne ■■"r■Mwe bslev hodarlrmajeoa
v+1u•ateia w1W t5A NCAC$Alll �- i ! :~
Y. Y1ELD(gpm): METHOD OF TEST-_� t
10.WATER ZONES(depth): 51 6 ---!
11. DISINFECTION:Type (t om a Amount ,nr p Show,
Itti
12. CASING: Wall 76iclma� two Slate Roads or ht Wiles feoutat least
Depth Die or Way L Materiel numbaa rgtruno�y Roads.Include the rued
1vm" O To�aFt — — L \ dnames
FmnL __To Ft C' V-
13. GROUT: D:ptb Material Method
F"m 0 To q 0 FL {�
From To Ft ---I
14- SCREEN: Depth Dkmcta Slm Size material
From To FL in. , f t L _p,/•
From To Ft in. _ in. ✓'� ""
15. SAND/ORAVEL,PACK:
Def" Sim Material 7l:ra-`CO
From To FL QLe UP
From To FL P
16. REMARKS: f (.� elh-'V , l
I DO NP.REHY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUC)ION STANDARDS,AND THAT A COPY OF T?RS RECORD HAS HEEN PROVIDED TO THE WELL OWNER
SIGNATU FP ERSONCONnMUCTTNGTHEWELL DATE
Submit the trriliinai CO the D[vhdou of Wstm Quality,Groundwater Scelion,1636 Mail Service Center-Raleigh,NC
176"-16%Pboex Na(919)733-3221,within 30 days. GW-1 REV.07/2001

WELL CONSTRUCTION RECORD
North Carolina-DepaMa:nt of Environni a(and�Nagtural Roamuces- iviston of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAM t)_ t1/N'P 65 �
CERTIPICATION2P
WELLCONTRACrORCOMPANYNAME S oS ' Well ll rl Iltn�_PRorixir aver-.�i/3j
STATE WELL COolicab 1C1'ION PERPtIia SpC(ATEO W((PERMIT#
ffa
(ifappliabk) AR (if applicable)
I. WELL USE(Check Applicable Boa):Residential it MtnioipaWtiblie(3 Industrial❑ Agricultural O
Monitoring 0 Recovery O Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: —� To(IographictLand setting
N Town: Y�R County C r0' K (' Midge PSlopc Malley 13 lat
(Speer Name.NmnbcM Cwmnm.6 heckitude, twelll
y.subdivision.[a Na,T.ip Code) Latituddlongitude of well Ipcation
3. OWNER: LT cc—Kp,4 (agp�nmvamsecamb)
Address U Q ZAt-_,� _ La(ituddlongitudesourcc:OGPS0TopoLnphicmap
(�t mama No.L (emo )
F�m l C' DrP
TH City miowo 4ae Zip CodeFr —To Formation Dose p n
A¢a eMe.Phme mmkbc ..j
4. DATE DRILLED -/ - 65 K, I/ .4 n iYjf
5. TOTAL DEPTH: -_- ,
6. DOES WELL REPLACE EXISTING WELL? YES O NOT -
'-07
7. STATIC WATER[iVF1.Below Top of Casiog: . (A
8. TOP OF CASING IS
FT.Above tans Surfaec• D
"Tep a(raalpa hrwmalvd Wa below land svrfatt regales a
variaea is teardauer whb 1SA NCAC 2C-011s. C"f
9. YIELD(Spin): I b METHOD OF TEST n
N
10.WATER ZONES(depth):
LOCATION SKFT('N •"
]I. DISINFECTION:Type �'+ o n Amount I V PPnt Show direction and distance in miles lmin at least
12. CASING: WAU Thichucas two State Roads or County Roads.Include the road
Depth D' er m Wei bFr. Material numlim and cot n road perm.en.
From C7 To -
Ft. lea �� ,t L!�( 1 h'
From To Ft. V 0
Frollt,—To FL / U, d / �-
13. GROUT: Depth Material Method
From_ToQQ Ft. _Qe joren+ Q
Frain To FL
14. SCREEN: Depth Diameter Slot Size Material
From To FL_in. in.
From To FL in. in. j
15. SANDIGRAVEL PACK: a ��
Depth Sim Material
From To FL 0'
From Tc FL
16. REMARKS: 42A ie4 G a vnJ,I y
7�'rvnJ
100 HRRERY CERTIFY THAT THIS WELL WAS CONSTRUCTED 1N ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,/INDTHAT AC SPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG TURF OF PERSON CONSTRUCTING THE WELL DAIS
Submit the Willies]to the p(vislon of Water Quality,Groundwater Section,1636 Mall Service Center-Ralelah,NC
27699-1636 Phone Nu.[phone],within 30 days. GW-I REV.072001

J k i6 �,'
WELL CONSTRUCTION RECORD
North Carolina-Dcliartment of Environment and N�atural Reso==--Division of Waler Quality-Groundwater Secnor
WELL CONTRACTOR QNDIV)DUAL)NAMEJ#i-ot) WAv n)_f P (yl�tlse CERTIFICATION 0 Ob9
VMLLCOttIAACTORCOMPANYNItg A _T(tf15P15 WJrk \ IJr,lltn? PHONE 3 a- 43l
STATE WELL CONSTRUCTION]PERMITS .Li5OMTW WQ PERMIT#
(ifaDDlitable) (ifaPP)ie+bk)
1. WELL USE(Check Applicable Box):Residential 0 MutieipaWtiblie O ln1110drial❑ Agric dbual O
Monitoring O Recovery O Heat Pump Water Injection O Other O If Odra,List Use
2. WELL LOCATION: TopogiaphidL.end setting
Nearest Town: Ms4rCounty v6 kjoo� ❑Ridge JOSlopc OValley ❑Flat
Often Nu k Naaaofem Cmemaahy.Sbmvatm.Ian Na-Tap Code) Latitudenongitude of well location
3. OWNER:-mP II I n `lASlyb "'r, (d4va+/sautes seeoneh)
Address _ 'T t�_(" .,4P 11 LatitudcAongitude source:DGPSOTopogmpbic map
(Seed a Heaae No.) (cheek boy
rn� f)1 a t �. oZi(�t n OfePTH DRILLING LOG
Cary err wd r,r�a+e Lp cmc lmm To Fot�on Description
4. DATE DRILLED _0 5
5. TOTAL DEPTH: ^� y
6. DOES WELL REPLAN EXISTING WELL? YES D NO
7. STATIC WATER LEVEL Below Top of Casing:.5 y FT. —'VT—
(Um"t^ilAMve TvpofCvsiag)
8. TOP OF CASING)S��FT.Above Land Surface'
'Tap of adaa lerwmYvd*L*below had 101171M rgdra a
variaaleie accord with ISA NCAC 3C.011a.
9. YIELD(gpm): _METHOD OF TEST, e - e--1 z°
10.WATER ZONES(depth): �(h } ul _
LOCATION SKETCH
It. DISINFECTION:Typi;29•1 nT.,.P Alnoamt Show llireelieNt and distance in miles from a least -k
12. CASING: Wall Thiclmcss two State Roads�unty Roads.Include the road
Depth . ®maa or W ' YFt. Material nmbers and corms on read names.
om L7
Ft To--9,- Ft-
-
From To FL- STFY�f /
From_To FL `Z /
13. GROUT: Depth Material Metlwd
from t To9_Ft. CP t�-e n'l G r 1
Fnlm To FL - 1
14. SCREEN: DcA Diameter Slot Sim Material
Fmm To FL in. tn.
From To FLin. in. ,
15. SAND/GRAVELPACK:
Depth Sim Material
From Te FL
From To FL --'-----��`
16. REMARKS: l'' t`r�tL Cc1.L
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY O'THUS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG E OF PERSON CONSTRUCI7NG THE WELL DATE
Submit the orional to tie Atvtadon of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
276994636 Phone No.[phone],within 30 Hayti. GW-I REV.072001

WELL CONSTRUCTION RECORD
North Carolina-Depaztment of Euvironmcat and Nawral Rftou cea!-Division of-Wafer
f Wafer Quality-Groundwater Section
NTR WELLCOAC(OR(HUNVIDUAL)NAME(POW)AA A I7n P- �{6 S,Ci
( � (( CERTIFICATION a0
WELLt:OtiIRACfgR COMPANY NAME �S e 4 WP 1 I Tl .'1 nz
( 'tFc3 SEAYE WEI.LLONSIRUCI'R)N lERMtiW PHONE aARSOCIATED W((PERMI7Y
>C liabk
low (if inbk
L WELL USE(Check Applicable,Box):Residential M al/Public 17 Industrial Cl
Agricultural O
Monitoring O Rocovezy [IHeat PumW Water Injection ClOther 0 If Other.List Use
2. WELL LOCATION:
Nearca Town 12i County(/ � Topo taphi1 Ovasetting
�SDr� ey 01 Qy rn ORidge lop' Ova OFiat
(Coed Nwue.Nmohcm Cmveuetr.5ubd visie L Em No- r-p C"w )' t�tud inong��cccttk��ituudappe of well location
3. OWNER:X)4VW RPhJ
Addtrss LalitadeAon ttdeta� )
T o<aadC No p y gi soutcc:oGPSOTopographic map
(chmk box)
Gtyar..wo book, zipcmr C Fr DEEM o DR(Ll_WLt1C
Fomtalim Deacription
Atnmde•Nmnesu®6d
4, DATE DRILLED I— !c 6. DOES WELL
5. TOTAL DEFT _?
7. STATIC WATER LEVEL ERISTING WF.LL7 YES O NO _
REPLACE
Below Top ofCasiw IFT --- C/) _ '
(Umw^aAboae Tq.u(Cesi g) •`
8. TOP OF CASING IS 5 FT.Above Latd Surfsec`
eTep of coming/wieWd War below Iwrid wrfaac rqulw a p. i
veriaaxia Uftrdauur wls ISA NCAC 2C AID.
9. YIELD(gpm). METHFTEST�
10.WATER ZONES(depth): -C'1- -
LOCATION S1cFTc'H
If. DISINFECTION:TypeC{t(t7 'r\e Amomt �LYI m _ Show direction anddistaoceihmileafimnatleast
12. CASING: Wall Uic►vess two State Roads or County Roads Includyimd
FromOepah n/ Viewer or WpghNFi STPkrpel) numMzs caraad names.
_To Ft- en
From_ _To Ft�/� /.5 .2?ee/Fraq To Ft13. GROUT: Dcp(h Material Mctlmd
o FromTo Ft14. SCREEN: Depth Dioneam Sim Sire MataidFlom To Rin. in.
From To FL_ia in.
15. SAND/GRAVEL PACK:Depth Sire Material
Fttnn To Ft
From To Ft
16. REMARKS;
P✓"l-)
100 HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C.WELL
CONSTRUCTION STANDARDS,AN TOT A COPY OF T S RECORD HAS BEEN PROVIDED TO THg WELL OWNER
Al f�-- 1U-®5--
SIGNATURE OF PERSON CONSTRUCTING THEWE(.L DATE
Submit the otigiflal to the Dlvidon of Water Quality,Gnmidwater section,16M Mail Se"Ice Center-Rakich,NC
vm-It m Pbom Nm(919)733-32ri,within 30 dayt: GW-1 REV.072001

WELL CONSTRUCTION RECORD UJ Q) U, j
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prinQ WILLIAM BRADLEY LEWIS CERTIFICATION 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PRONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIr#
1110000110 (if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural[3❑Monitoring Recovery ❑ Heat Pump Water eetion❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo raphic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
TANGLEWOOD check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3507.035N 8401.635W
3. OWNER: BLAIR SCHRADER (degrees/min tes/seconds)
Address 132 OLD DOGWOOD DR. Latitude/longitude source: GPS❑Topographic map
(Street or Route No.) ��,(c eck box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town Slate Zip Code From TO Formation Description
8( 28 )-837-1529 U TO 5' RED DIRT
Area code-Phone number U TO 31' DARK BLUE GRANITE
4. DATE DRILLED 09/14/05 31'TO 405' GRANITE
5. TOTAL DEPTH: 405'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 1 oo
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Lard Surface*
•Top of casing terminated at/or below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 3 METHOD OF TEST AIR
10. WATER ZONES(depth): 300,340
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two Slate Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 31' Ft. 6 1/8 SDR 21 PVC
From To FL
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' Ft.CEMENT GRAVITY
From To FL r-ri
14. SCREEN: Depth Diameter Slot Size Material -v
fU
From To FL in. in. O
From To Ft. in. in. o
15. SAND/GRAVEL PACK:
Depth Size Material
Front-To-FL
From To Ft.
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 TILE WELL OWNER
SIGNATURE OF PER60N CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR MMFVMUAL)NAME (priat) JOHN ARTHUR CHASTAIN CERTIFICATION#3401
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PRONE # (82A 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residentia Municipal/Public❑ Industrial❑ Agricultural❑
❑Monitoring Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo raphic/Land setting
Nearest Town: NJ,i County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
SCHULERMTN. RD. ( eckappropriatebox)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: DAVID REED (degrees/minutes/seconds)
Address 129 OCEAN GARDEN LANE Latitude/longitude source:❑GPS❑Topographic map
/� (Street or Rome No.) (check box)
PE I CA WAUER,4L FL 32920 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
868-2281 0'TO 15' BROWN CLAY
Area code-Phone number 15'TO 40' YELLOW SHALE
4. DATE DRILLED 08/22/05 40'TO 605' BLACK GRANITE
5. TOTAL DEPTH: 605'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL.Below Top of Casing: 75
(Use"+"if Above Top of Casing) N -,
8. TOP OF CASING IS 1 FT. Above Land Surface* v
`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): 255'
550, LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 700 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road
From 0' To 60' Ft. 6 118 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' Ft CEMENT GRAVITY
From To FL
14. SCREEN: Depth Diameter Slot Size Material (�,c,,,' I l;I
From To Ft. in. in. _ r✓ � T
From To Ft.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE-OF PERSON CONSTRUCTING THE WELL A. ,
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 3 1
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prto<t) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP GO.INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential�I Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water ection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographicd setting
Nearest Town: aPAI County CHEROKEE ❑Ridge ❑S1opeValley ❑Flat
141 TO PINEY RD. 'COOK FARM' (check appro n box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: WINDELL ANDERSON (degreeshuimnes/seconds)
Address 1425 BURNT SCHOOLHOUSE Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
)MILS V I t-t E NC 28904 DEPTH DRILLING LOG
City or Town state Zip code From To Formation Description
8( 2B )-389-8986 0'TO 20' RED DIRT
Area code-Phone number 20'TO 40' RED DIRT/15ft.GRANITE
4. DATE DRILLED 09l13/OS 40'TO60' GRAVEUBROWN DIRT
5. TOTAL DEPTH: 385' 60'TO 73' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 73'TO 385' GRANITE
7. STATIC WATER LEVEL Below Top of Casing: 50
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of rasing terminated atlor below rand surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 10 METHOD OF TEST AIR
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the mad
Depth Diameter or Weight/Ft. Material numbers and common road names.
From U To 7T 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 0' To 100' Ft.HOL-PLUG GRAVITY
14. SCREEN: Depth Diameter Slot Size Material
From TO Ft. in. in U
From To Ft. in in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft CD
16. REMARKS:too FT. SEAL PACK CD
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
—914(,rd6 C. t7.v C& ► N
SIGNATURE OF PERSY CONSTRUCTING THE WELL DAT5
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD t
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING B PUMP CO.INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMITO
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
❑Monitoring❑ Recovery Heat Pump Water n ction❑ Other❑ If Other,List Use
2. WELL LOCATION: Top o raphic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
WARREN DRIVE (lh4ek appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3504.728N 8403.265W
3. OWNER: JOHNNY PRATHER (degrees/minu�tfs/seconds)
Address PO BOX 1126 Latitude/longitude source:U1GPS❑Topographic map
(Street or Route No.) �( eck box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
8( 28)-837-7817 O'TO 10' GRAVEL
Area code-Phone number 1 O'TO 40' RED BROWN SLATE
4. DATE DRILLED 08117/05 40'TO 80' BROWN SLATE
5. TOTAL DEPTH: 605' y, 80'TO 110' TAN BROWN SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 11 O'TO 140' BLUE SLATE
7. STATIC WATER LEVEL Below Top of Casing: 150 140'TO 605' GRANITE
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS 1 FT.Above Land Surface*
•Top of casing terminated aHor below land surface requires a
variance In accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 4 METHOD OF TEST AIR
10. WATER ZONES(depth): 240' BIT SIZE 6.056
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common I
fmrrres.
From 9To 140' Ft. 6 118 SDR 21 PVC
From To Ft. -
From To F[.
13. GROUT: Depth Material Method L
From 0' To 20' Ft.CEMENT GRAVITY
From To Ft. s ry
14. SCREEN: Depth Diameter Slot Size Material
7
From To Ft. in. in. - --- CD
From To Ft. in. in. T0.rheP1 ;
15. SAND/GRAVEL PACK: Or 0
Depth Size Material
From To FL
From To Ft. 9
16. REMARKS: t e
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
6 adj'w >i»n 1)�jg,4(s
SIGNATURE OF PER O SISTR CTING TIIE WELL DATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days
GW-I REV.09/2004

RECORD
WELL CONSTRUCTION i'
L RD �
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PRONE # [phone]
STATE WELL CONSTRUCrION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
01111
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water action❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:ANDREWS County CHEROKEE ❑Ridge ❑Slope ❑Valley ❑Flat
JUNALUSKA (check appropriate box)
(Street Name,Numbers,Community,subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3511.096N 8346.553W
3, OWNER: NICHOLAS RUGGERI (degrees/minutes/seconds)
Address PO BOX 1589 LatitudeAongitude source:&PS❑Topographic trap
(Street or Route No.) check box)
ANDREWS NC 28901 DEPTH DRILLING LOG
City or Tnwn wade Zip code From TO Formation Description
8( 28 )-321-2222 O'TO 10' BLACK DIRT
Area code-Phone number 4. DATE DRILLED 09/08/05 1 O 10'TO 20' RED GRAY CLAY
5. TOTAL DEPTH: 'TO 0' BROWN DIRT
40'TO 60' BROWN DIRT TO BROWN SLATE
6. DOES WELL REPLALA CE EXISTING WELL? YES❑ NO X 60'TO 82' DARK BLUE SLATE
7. STATIC WATER LEVEL Below Top of Casing: 100 82'TO 325' SLATE
(Use'+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surfacer
•Top of casing terminated at/or below land surface requires a
variance In accordance with 15A NCAC 2C.01/8.
9. YIELD(gpm): 10 METHOD OF TEST AIR
10. WATER ZONES(depth): 300,10
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 10O PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include die road
Depth Diameter or Weight/Ft. Material numbers and common road flames.
From 0' To SZ Ft, 6 118 SDR 21 PVC
From To Ft.
From To Ft. -
13. GROUT: Depth Material Method
From 0' To 20' F 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: -
r,
Depth Size Material
From To Ft. ---.
From To Ft.
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 TIIE WELL OWNER
SIGNATURE OF R N CONSTRUCTING IITE WELL 9 ATff
Submit the original to the Division of Water Quality,Ann: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004

WELL CONSTRUCTION RECORD ;
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (priM) JOHN ARTHUR CHASTAIN CERTIFICATION#3401
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PHONE # (a28)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential I Mulucipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water ction❑ Other❑ If Other,List Use
2. WELL LOCATION: �! Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE pORidge ❑Slope ❑Valley ❑Flat
SOARING EAGLE / (check appropriate box)
(Street Nettle,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: BOB FARVER (degrees/minutes/seconds)
Address PO BOX 151 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 2890b DEPTH DRILLING LOG
City or Town Slate Zip Code From TO Forriation Description
8( 28 )-837-0185 O'TO 18' FILL DIRT
Area code-Phone number 18'TO 25' BROWN DIRT
4. DATE DRILLED 09109/05 25'TO 45' BROWN DIRT5AN0ST0NVGRANRE
5. TOTAL DEPTH: 745' 45'TO 53' GRANITE/SET CASING
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO f 53'TO 745' GRANITE
7. STATIC WATER LEVEL Below Top of Casing: 400
(Use"+"if Above Top of Casing)
S. TOP OF CASING IS 1 FT. Above Land Surface* T• __._. _._-_ j
-Top of easing terminated at/or below land surrace requires a
variance In accordance with 15A NCAC 2C.0118. w
9. YIELD(gpm): 5 METHOD OF TEST AIR
10. WATER ZONES(depth): 180,450,580
LOCATION SKETCH '
11. DISINFECTION:Type CHLORINE Amount 10O PPM Show direction find distance irorniks from at least
12. CASING: Wall Thickness two State_RoalS_or Cot(+_rty)Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 53' Ft. 61/8 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' FL CEMENT GRAVITY
From To Ft V�
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK: Jj
Depth Size Material
From To Ft.
Fmm To FL � r( rri _
16. REMARKS: [ JU C
o "
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL U1
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING 711E WELL DATE i
Submit the original to the Division of Water Quality,Attn:Information Managtmlent,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

O�ATION RECORD ( a �4North Carolina Department of Environment and Natural Resources-Division of Water Quality
-- WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: _
f. DISINFECTION:Type Amount Z .
f).m("klf\ 9. WATER ZONES(depth):
vv ell uruiauw (YYIVItDBI)Name '
/� _ From�b To. `a� From Tc
wAili, l C). From To
Well Contractor Company Natme From To
STREET ADDRESS J QGa 1 Y t A�s R� 6. CASING:FrOrn TO From To
Thickness/
^ T Depth Demeter Weight Material
�-X From lJ To��Ft.�_ Rent
�
CIty a Ttwn State Zip Code From 1.Y4\�
To Ft.
<S'r From To Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL ID#(if applicable) From 0 TO-Ob Ft- I�CP,S AYe
Fran To Ft.
STATE WELL PERMIT#(dapplicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable)
^ 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply LIl/ From To - Ft. in. _ in.
DATE DRILLED /`I-Ia AYu —)l+_ 05 Fran TD Ft. in. _ in.
TIME COMPLETED LI� AM❑ PM U;/ Fran TO Ft. in. _ in,
S. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth
1' L��Y'() From To Ft
CITY: Size Material
^16 From To Ft.
"I`I 1-IL Ir.�,^ StoP dl h� rat OC/��ij From To(Street ,e,Numbers,Community,Subdi-Ah.LG N°.,Parcel,Zip Corlej Ft.
TOPOG IC/LAND SETTING:
❑Valley ❑Flat ❑Ridge ❑Other 10.DRILLING LOG
(check appropriate box) From To t Formation Description
LATITUDE 3 — May he rn degrees, -ilia 1 C ` ^c l"C In C ')i \ 6'\
minutes,sewrMs a 2
LONGITUDE in a decimal fomrat ) `
Latitude/longitude source: ❑GPS ❑Topographic map
(location
attached to his form I nol must be t using GPS)wn on a GS topo map and ��^_ r — f -
4.WELL OWNER
OWNER'S NAME p q:T`>
STREET ADDRES� F��L� �ry- .
a�City F „ State Zip Code W
G
L1 >U�ru - u )
Area code- Phone number _
S.WELL DETAILS: ,C' r 11. REMARKS: :.A
a. TOTAL DEPTH:_
It. DOES WELL REPLACE EXISTING WELL? YES❑ NO
C. WATER LEVEL Beim Top of Casing: + FT I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
(Use'+•6 Above Top of Casing) TSA NCAC 2C,WELL CONSTRUCTON STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP CASING I �-F Above Land Surface
'Topp of casing terminated
ith w belay land Aboveand surface may require a variance in accordance with 15A NCAC 2C SIGNATURE
.0118. D WE L CONTRACTOR DATE
e. YIELD(gilm):�_METHOD OF TEST_Bjp Q \�VVVVVV\*
rKIN I tU NAMC.AF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Form GW-la
REV.7/05

I
l< RESIDENTIAL WELL CONSTRUCTION RECORD 3 �P
�Y•.� ''I�=; North Carolina Department of Environment and Natural Resources Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 52UeS
1.WELL CONTRACTOR: 1 _ I. DISINFECTION:Types hlnrve Am ant
liNil lt1P(Y i'Jf(VA`PL Lzuiyc, g. WATER ZONES(depth):
/W��ell�Contractor(individual)Name I From To dqc From To
LJ uc!Y !Lxm L)QAk NrilI 1Mi 1n . Iloc. From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO LJLIL 1m1 6. CASING: Thicknessr
rr��11 Depth Diameter We' ht Material
�l1Cl)IN_�� rn From�To.�1.�1 fl.1�'!LI �
CI or Yawn State Zip Code From To Ft.
•b_'_ From To Ft.
Area code- Phone number
2.WELL INFORMATION:
7. GROUT: Depth Material Method
rr��
From C���_To-aU_FL_U Yj2A G f0N i jq
SITE WELL ID C(if applicable) From To R.-
STATE WELL PERMITV applicable) From To R
DWQ or OTHER PERMIT R(l applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply❑ From To FL—in. _ in.
From TO Ft.—in. _ in.
DATE DRILLED 1(�01 •®� From_To R._in. in.
TIME COMPLETED AM❑ PM❑ 9, SANDIGRAVEL PACK:
3.WELL L�O-(C�ATIO,,,�,N1111:����'''� �_`'�, Depth Size Material
CITY: lL ilyd Yam_ COUNTYS CT[]Y�'c_ From To FL
-
I � [n'�, From To Ft.
. iutli. t"•Ll . From To Ft.
(Street Name,Numbers,Community,Subdimsion,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑valley AlFlat ❑Ridge ❑Other From To Formation Description
(check appropriate box) `IT �O R . \ \ t p
May be in Degrees,
^
LATITUDE 3 � �,5.+�N minute,seconds or Cz�t ��r _
LONGITUDE$ 3 S'7 . :[1 L1 or a decimal format lanr
Latitude/longitude source: �GPS ❑Topographic map �I x1,
(focatian of wet must be shown on a USGS topo map and
attached to this form roar using GPS)
4.WELL OWNER (�� /'1 1
OWNER'S NAME Pa^r1n.;CCCU\ �bTYI'G�1C,av ice_
STREET ADDRESS�.l.n ` )\ %,p 9-6
Ciy a Tie Zip Code
Area code- Phone number
S.WELL DETAILS: 11. REMARKS: o�c LrI ,
a. TOTAL DEPTH, i T
b. DOES WELL REPLACE EXISTING WELL? YES(j NO
WHEREBY CERTIFYTHAT THIS WELL WAS CDNSml1CTED IN ACCORDANCE WriH
c. WATER LEVEL Below Top of Casing: Is FT. I'M 14 A W.WELL CONSmUCT10N STANDARDS,AND THATA CWY OF THIS
(Use'+'l Above Top of Casing) RECORD HAS BEEN PROVIDED TOTHE WELL OWNER.
d. TOP OF CASING IS_ 1 FT.Above Land Surface' �I ��AA�� � �g� �-T 10106
'Top d casing terminated at/or below land surface may require A'�Y --�-L I ti� ���) i--iT.e-LTE
a variance In accordance with 15A NCAC 2C.0118. SIGNATURE OF CER7IFI EL1L CONTRACTOR DATE
e. YIELD(gpm):�_METHOD OF TEST Lit- PRINTED ME PEON EO TRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, FortnGW-la
1617 Mail Service Center—Raleigh,NC 27699.1617 Phone No.[phone] ext 568... - Rev.7/05

..pp
/'...,..�" �T ! 6 � <) OWNER
dP,
1 i o RESIDENTIAL WELL CONSTRUCTION RECO►(D MWD
North Carolina Department of Environment and Natural Resources-Division of Water Quality ✓,
NC
WELL CONTRACTOR CERTIFICATION H
1.WELL CONTRACTOR: f. DISINFECTION:Type YZL/ Amount �Z CU/�
Ph, 1, r g. WATER ZONES(depth):
Well Contractor(Individual)Name From L 75 To /80 From 310 To 3�_
MILLER WELL DRILLING . INC . From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P . D . B(I X 58 7 6. CASING: Thickness)
HAYESVILLE . N . C . 28904 Froml Tolh7(1 Ft. DiameterSWeg/ Mf/Url-
±r
City or Town State Zip Code Fran To Fr.
t 828 } 837-2997 From To Ft.
Area code- Phone number
2.WELL INFORMATION: �I
T. GROUT: Depth Material Method
SREWELLID#(itepplicable) From 3 To aO Ft. 1,CNfPN;fC Urnp
From 6 To 3 Ft. ORT/4-,1 It 11/a('
STATE WELL PERMIT#(il applicable) From To FL —
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply Er, From To—Ft.—In. _ In.
_ From To Ft.—In. _ in.
DATE DRILLED From To—FL—in. In.
TIME COMPLETED 3 30 AMD PMUj� 9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
From To Ft.
CITY: f 10 PJ COUNTY C 77c'/°�K�e From To Ft.
�O�i���Lti/3ii✓ ` O C �wCS(e 21h }1 Fran To Ft.
(�Ifeel Name,Numbers,Community,SubdiWdon,Lo 6 Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10. DRILLING LOG
�ope DValley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box)
I May be in degrees.
LATITUDE 3 1 minules.secondsor ��-76
LONGITUDE SLIP a s.S-Lf3 ' in a decimal format
Latitudellongitude source: Q1 PS OTopogiaphic map
(location of wet must be shown on a USGS lopo map and ...
attached to this farm A not using GPS) C3
4.WELL OWNER
1 �
OWNER-SNAME
STREET ADDRESS
MI.yrltiu A/[ Z9406 T
City a Tcs4n Stale Zip Code -
t }
Area code- Phone number
11. . REh1ARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: 3�S `
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
e. WATER LEVEL Below Top of Casing: 70 FT. 1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WRN
15A NCAC 2C.WELL CONSTRUCTION STANDARDS.AND THATA COPY OF THIS
(Use'•'d Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS_L FT.Above Land Surface' / RQ�.y.� /�_�S"
'Top of casing terminated al/or below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR JJ DATE
a variance in accordance with 15A NCACr2C.0118.
e. YIELD(gpm): 0 METHOD OF TEST ?W b p
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 566. � cw•ta
Rev.7/05

WELL CONSTRUCTION RECORD V11
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(OWIVIDUAL)NAME (print) JOHN ARTHUR CHASTAIN CERTIFICATION#3401
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC PHONE # (828)B37-8008
STATE WELL CONSTRUCTION PERNHU ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residentialm MucipaliPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water ction❑ Other❑ If Other,List Use
2. WELL LOCATION: ' Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE PRidge ❑Slope ❑Valley ❑Flat
403 LAUREL BROOK DRIVE (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3502.642N 8411.255W
3. OWNER: DONALD MORRIS&JOAN MELVIN (degrees/mimrtes/seconds)
Address 581 TWIN MOUNTAIN RD. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28 )_644-5155 0'TO 15' SANDSTONE
Area code-Phone number 15'TO 25' GRANITE/SET CASING
4. DATE DRILLED OWO/05 25'TO 705' GRANITE
5. TOTAL DEPTH: 705'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO e n ?
7. STATIC WATER LEVEL Below Top of Casing: 140 rn
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
*Top of casing terminated at/or below lard surface requires a _
variance in accordance with 15A NCAC 2C.0118. E
9. YIELD(gpm): 3/4 METHOD OF TEST AIR
10. WATER ZONES(depth): LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 26 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 VNJ��
From To Ft. �O iJp
14. SCREEN: Depth Diameter Slot Size Mateial •r
From To Ft. in. in. O�
From TO Ft. in. in.
15. SAND/GRAVEL PACK: �J<'
Depth Size Material
From To Ft.
From To Ft
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONS•jgUCTTNG THE WELL
Submit the original to the Division of Water Quality,Aft::bh olmatiou Managtmlent,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 3Q days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD DO 16 t 2
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print), WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC PHONE # [phone]
SPATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential MunicipattPubhc❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water gection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo raphic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
FLOYD STALCUP RD. AIR appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: MIKE ADAMS (degrees/minutes/seconds)
Address 504 FLOYD STALCUP RD. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Cede From TO Formation Description
8( 28 )-837-5818 O'TO 40' BROWN TAN SLATE
Area code-Phone number 40'TO 57' DARK BLUE SLATE
4. DATE DRILLED 09/19/05 57'TO 365' SLATE -
5. TOTAL DEPTH: 365'
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NOj
7. STATIC WATER LEVEL Below Top of Casing: 50
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface* N
•Top of casing terminated at/or below land surface requires a
variance in accerdancewith 15A NCAC 2C.0118.
9. YIELD(gpm): 1 1/4 METHOD OF TEST AIR
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 10o PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 5r Ft. 6 118 SDR 21 PVC
From To Ft.
From To FL
13. GROUT: Depth Material Method
From 0' To 20' FL CEMENT GRAVITY r ,
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in. j
From To FL—in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft. n n,
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
2w e'-)" ji't On P_e4l'rin IQl��Q�
SIGNATDRE OF PERSON CONSTRUCTING Tl IE WELL OATE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) JOHNCHASTAIN CERTIFICATION 3401
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING 8 PUMP CO.INC PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural[I❑Monitoring❑ Recovery Heat Pump Water n)eclion❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE Ridge ❑Slope ❑Valley ❑Flat
INDIAN ROCK SPRINGS (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: MARY BICKNESS C/O JEFF KEEN (degrees/minutes/seconds)
Address 78 ALMOSTA RD. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation DCSCription
8( 28 )-361-6975 V TO 18' BROWN DIRT
Area code-Phone number 18'TO 35' SANDSTONE
4. DATE DRILLED 09/15/05 35'TO 53' GRANITE/SET CASING
5. TOTAL DEPTH: 605' 53'TO 605' GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 500
(Use"+"if Above Top of Casing) ~
8. TOP OF CASING IS 1 Fr. Above Land Surface*
-Top of casing terminated actor below land surface requires a .P
variance in accordance with 15A NCAC 2C.011& r
9. YIELD(gpm): 2 METHOD OF TEST AIR
10. WATER ZONES(depth): 190' u1
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickttess two Slate Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 53' 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. y
From To Ft. in. in. .
15. SAND/GRAVEL PACK:
Depth Size Material
From-To Ft.
From To FL f�
16. REMARKS: P i ✓`
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING T1IE WELL DA E
Submit the original to the Division of Water Quality,Attnt Information Management,1617 Mall Service Center-
Raleigh,NC 27699-1617, Phone No.[phone]t 1within 30 days.
GW-I REV.09/2004

NC s' ^+ � UIVNLR MII'U
---- -------- -------
WELL CONSTRUCTION lUsCOAD .4 Is
Not at Carolina-Depai Intent of Envimu ncill mid',N``olutal Itesoulceess-Div Isloll of Water Quality-Utoundwaler Seclium
WELL CON IMCfOII(INDIVIDUAL)NAME (priel) L—(1,13�E� Fl < A<GQ CERIFIPICAIRM rayoy
WELL CONT RACIOR COM PANT'NAME Lk)r1.S0eA A')p � Ar;.jk:e1q —rtwNE " fY1rASs'.3y'n4Gt
STATE WELL CONS IRUCI IUN rERAIIT" ASSOCIAI Ell WQ PERA11iN
(tfnpplicnblc) (If n(grlicnlrlc)__
1. WELL USE(Check Applicable Dun): Residculinl 41-Im olcipul/Pubile LJ Indusltial CI Agricultural U
Monilm ing❑ Recovery U licat Pump Water bijectiml U Olher U If Other,List Use
2. W ELL LOCA'IION: Topogrnphic/Lond ;citing
NemestTown::1 Cumuy _p Q OlUdge C/181'upe Malley UFlal
Tw,o fn�Fes. S F.l�p/,ytm (clink ePPrrTr tale box)
(Sweet Neure,Nu libels,Coruuurlry,Subditfier,Lot No.. ill Cale) Lalitudellongilude of well location
3. OWNER: c I�Q, � .,N.t Dt]VIS (deprerdndnoirdrnondr)
Address D Bass all f Latitude/lougiludesource:C1GPSOTopuglopliicmiap
(Swett or Route Ile.) (clink boa)
�r. cc�eran ge, afr9OJ UEI'T11 ULLLLNQLOU
Cityer Town stale Zip Cale Flour To •on wlion Ucsci iplion
pip _ sit T - 1'S OO b n
Afro tale-rhone oimrber
4, DATE DRILLED A'hi - OS SS' — ASS Ix
5. I'OFAL DLPTIL• a.%S'
6. DOES WELL REI'LACH EXIST INO WELL? YES 0 NO IiY
7. STATIC WATEit LEVEL Uclow Top of Cnsiug: 15 .17 f.
(One"+'If Above1 asp of Debra)
B. TOT' OP CASING IS 1 1'I'.Above I-null Surface• T,
.Top or taster irnntnoird over below End our lure trquh to• _
tntante In onerderire with ISA NCAC IC.eI la. -
9. YIELD(Prat): 25 METHOD OF TE-Sr
10.WATER ZONES(depth): LOCAINV SKETCH
11. DISINFECTION:Typeh Amoutd IS Show direction and distance In miles front at(cast
12. CASING: Wnll'Ihickness two Slate Roads or County Roads. Include We road
Ucpd, Dimncicr or Wcighvpt. Material nuluberm aulcoounon road Ranics.
rium (5 To y5' 1:1. (e IS -SPE21 ?lie _ 3 . _ ej
Ftomt To fl. 7ads
From To FL
13. GROUr: Depal hlialcrial Mc iod
Flon(_Q_7o_2c pl•
Flom To Fl. y
14. SCREEN: Depth Diameter Slut Size Malednl VA�yt ofa
Ftont To Fl- hl, lit•
from To 11111. in. �b �
15. SAND/GIIAVUL PACK:
Drpllt Size Mnterial �P
Fain Tn Fl.
Frain �rm FI. - �
16. REMARKS:
i DO IICItEDY CERNFY IIIAT'I I ITS WELL WAS CONS'17t(iCf[r.D IN ACCOIU)ANCE WII71 15A NCAC 2C,WI1Ll,
CONSIItUCf ION STA14DAIWS,AND TI IAT A COPY OFF)IIS RECORD HAS BEEN PROVIDED Toll III WELL OWNER
SIUNAlU11.E01:PERSONCONS IRUCI"INUI11113WELL DAIS
Subndl Ilie 01IghDid to the DlvisloIt of Water Quality,Croundwiller Section, 1636 b1all Service Coder-Italelgb,NC
27699-1636 rhoue No.[phone],within 3111 day+. OW-1 REV.07/20UI c

U IM E/i -----_—_ n `I
WELL CONSTRUCTION RE,C01W
Noidi Carolina-Dcpalbnent of L'uv!Iunnicnl told NaRnal Resources-Divislull of Water Quality-Groundwater Sect ion
�r
WELL CUNiRAC101t(INDIVIDUAL)NAAlE (phlnl) s )a+n�p G 3 LZI)So to CERIVIFICAT1ON 0,7g64
WELLCONTRACIORCOa1rANYNAME kZ I1 50A t ZP-11 4361il. /la ruoNE 0 [am C-S7-o9G,T
STATE WELL CONS f RUCI M4,ERA"'# ASSOCIATED WQ PE"111/
(if nrplicnblc) (if npplicnble) _
1. WELL USE(Clheck Applicable Dun): Itesidculiul "jualcipal/Public U htduatllal CI Agl{cultuial U
Mmlifoling[] Recovery U Heat Pump Water Injcciion U Other O If Other,List Use
2, WI:Lt.LOCATION: 'ropogrnphi✓Land Selling
NCa1C5l T'Utvm: NCol
�n.f County- erAm �udge []Slope Malley Ui:la(
MAhrres TA (check app+opttete box)
(Sucrt Name.Numbnonity,SubJivlelah,Lot No.,711,Cale) LaliluJdlmlgiluJo of well location
J, O1V NL:R: <J0An an n (kQ r-a Nr% (J[rteee/minnledrecnnd+)
AJJtcss ralarr°fa -TaA led S LatiluJdlougilude301,11 EJOPSOTupuglephic"'all
(Sheri m Route No.) (check box)
JxPrif DIULI'M LU(l
City or Ton Sete, Zip Cale I'roul To r-onlaliou m Descliptio
(_—) 0 _ $ C JQL/
Airs rule-rhone number .. $S' to vtA 4,r4 e-
d. DATI: DRILLED 9- 7-a5 � - �45 Grua ftz
5. TOI-ALOEPTII: :KL-5r
6. DOES WELL REPLACE EXIS'1'INO WELL? YES U NO IY Y
7. S"1'ATIC 1VATElt LEVEL Bcluw Toih orCnsimg:1e e Fr.
(tire"+-If Above lop of Ca+Ina) �
g. TOI'01--CASINO IS�_FE Above LnuJ Sul race* ---/
,Tap of calla,lermInalrd amor below land out fete requiter a i
n+lance In accordurre with ISA NCAC IC.01111. EP
9. YIELD(ppnl): 'id METHOD OI-TEST iv ie
10.WATER ZONES(depth): LOCATION SKE'rC)1 n
11. DISINrECI'ION:Type Amount 1 , Show direction and distance in rubes frmn al lead
12. CASINO: Wall'lbickmess two Slate Roads or County Roads.Include We road
Dcpol Diameter or W eighVPL �Matellal number and conunon road names.
Fluln 1'0 y&t 1'I. 6,i5 � 1y `— r4grrCS
Flom To fl. ti 1-6 P
Frtnn ro 171.
13. 0ROUT: Dcplh Mmetial McWod
Front 3 To—�rlf �a
From�_ -PC 'O , 1119"tNeilfe, �0
14. SCREEN: DepOr Uialncler Slot Site Matellnl I
Flom To FI. hl. {tl. 1�
Aunt 'ru__17t, lu. 1u.
15. SANVIU AV1i1,VACK:
Depth Site hinlellnl
FIORD ro 1't.
from 'I'u Fl.
16. REMARKS:
i DO IIEREBY CERTIFY T11AT'I I IIS WELL WAS CONST'IMCILID W ACCORDANCE WITH ISA NCAC 2C,WELL
CONSTRUCTION STANDAJWS,AND TIIAT A COPY OF'i111S IIIiCORD UAS BEEN PROVIDED TO TIW WELL OWNER
�1- 7- as
SIGNMUIlE 01;PERSON CONS"IRUMINU 111E WELL DAZE
Submit Ille oliginnl to(he Divislon of\Vnler Qunli(y,Groulldwo(er Secllon, 16J6 Ma1lSetrlce Center-Italdgh,NC
21699-1616 Phone No.[phone],wl(Ilbl 311 day+, C)W-1 RLIV.01/2UOI

NC UIINEIt -
31 E E,\'V 00
WELL CONSTRUCTION
Nora,Carolina-Department of Envitomnent and Nntuial Resources-Division of Water Quality-Otoundwaler Section l'
WELL CONTRACTOR(INDIVIDUAL)NAME (print)\TDyne 5 -9 L�`11son CERTIFICATION1laYoy
WELL CONT RACIOR comrANY NAaIE l.a\: 1 60f tiA!!i ii A-eAt/iq r110NE N (YZW K3 Z'—bQ�ff
STATE WELL CONSTRUCI ION rERatfIN ASSOCIATED wQ rE"II IN -
nfar licnblc r_
(ifnlllicnllc) ('-�' ) 1
1. WELL USE(Check Applicable Dox): Residcntinl kd�hlludcipal/Public U Industrial ❑ Agricultural IJ
Mmliloling U Recovery ❑ llcal liuuq,Water hljeclioll U Other U If Odier,List Use
2. WELL LOCATION: Top°gm ,hic/Lml Malley
selling
N nr sITown, f Counly (ef tlk (r ❑Ridge ;Pope alley UFlat
d'� t (check epprnprinle box)
(Sueel Neine,N«nben,Cinnamnity,Subdirlsl«i,lot No.,7�p C«le) Laliludellongitude of well location .
I. DWNEit: oil s aur�ian
(degreeslminulesleaondQ ' �
Address 1156 warPoli% Dr LaliWdellongiludesoutce:❑CPS❑"fopoglaphicnlap I
(Street or,IRoble No.) (check box)
YVjr�rDbrrl ILL Cr �P94Cal PEP'1'11 j�LIL1�tJSL4U�
City or o.n sole zip C«le rloD li
l To •o ,Ialion Dcscripuu
(l2fr)_U6t-l.414'-e744 O - •10`
Ain cc-de.«hone number J - on r S
4. DATE DRILLED'-,2,?- p-S _(('pe
5. TOTAL DEPTII: o
6. DOES WELL REPLACE EXISTING WELL? YES U NO lid-
7. STATIC WATER LEVEL BelowT'opofCasiug: lOt9e 1"f. 1
(Use"+-If Above lap of Cueing)
g. TOP Or CASING IS I l f• Above Lnud Surfacc•
-Top of ndng Iennlo.led sDor below land surface requires a
valiance In accordance wllb ISA NCAC IC.9I IN. _
9. YIELD(gpnl): 2 Z& h1BTIlOD Or TESL'_
10.WATER ZONES (depth): LOCATION MM11
Show direction slid distance in miles from at least
12. CASINU'1. DISINFECTION:Type Amo°lit 15 two Stale Roads or County Roads. Include Ole road
CASING:
: WnIlThickncss
Delith Dimnelcr of WeighUrl. M��ahelial numbers and cornmon road names. ,�
Fronl�—To IAO Ft.�.25 � LVr_-- ,�� a oC
From To Fl. `1�
rr°m •rD Fl.
13. GROUT: Depul Material Method /'t)
FrollL. Q To_&L rt• r L
From 91 To Sr!_der Fl. 0
14. SCREEN: Depul Dialuelet Slot Size Malelial Y. 4*
From To Ft. in. iu. �oa►
Fm°l To_,_Ft, in, in.
15. SAND/GILAVEL PACK:
Depul Size Mntelial
Frond To Ft. -ZlF.
Ftom fD rl.
16. REhtnlLKS:
I DO HEREBY CERTIFY II IAT TI I IS WELL WAS CONSTRUCI ED IN ACCORDANCE WITH )5A NCAC 2C,W ELL
CONSTRUCT IONS FANDAIWS,AND THAT A COPY OF 1111S RECORD IIAS BEEN PROVIDED TO TILE WELL OWNER
• �; �.y �A 9-a3-us
SIGNAIUIILI UIr PERSON CONS'IRUCTINO IIIE WELL DATE
Submit the original to the Division of Water Qualify,Groundwater Section,1636 M■IlServlce Center-Raleigh,NC
27699-1636 Phone No.(919)733-322 1,11 Milli 30 days. OW-1 REV.07/2001

NC OiVNEl7 `? t '? ------- — -------- 0 Ay Vlf ! --
WELL CONSTRUCTION IMIX01 D
Ninth Carolina-Dcpathnent of Envitooutcul and Nalural Resources-Division of Water Quality-Oloundwater Section
'WELL CON TRACtolt(INDIVIDUAL)NAME (rthrq "-)QryApS tA7 r\1 n CERTIFICA71ON11�y
wELLCONTMCIOn CoaIrANVNAa1E i� >t1 St�Vl 1A712A ACI in-T_ruvNE 0 (k+rr1 its 7-69!_r
STATE wELL CONSTnUCIION VEM11TN ASSOCIA7"ED WQ PERMITN
(ifnpplicnblc) (Ifn(ryrlicnblc) '.:.:.- . '._..-
1. %VELL USG (Check Al)lrlicnble llos): Itcsidcnlial hJ'Muuleipal/Public LJ Indushinl CJ Agdculluial U
Munilol ing CI Recovery U Ilcal 1'uuq) Walcr htjewliun lJ Olhet IJ If Older,Llst Uae
2. WELL LOCATION: Topogrnphic/Lnnd selling
Ncolcsl7-own: rAlf� Cualdyr � `CPP IJIUdge ErKrvpe C1Vnllcy Urlal
a;, IA6LASQ- �- (checknrrroptlelebox)
(Sbret Naloe,,Numbar,Conuuonay,SubdMilmr,Lot No.,Z11,Ctnle) Latituddlougitude of well lucstiml
J. OWNGR: ((r� �WG1 d (degmex/minnledrecond.)
Address 1 Oc, War ram- �+ Df' Lathuddlongilude source:EIGPSOlbpogiaphic nwp
(St,eel m Roule No.) (check box)
nib 2 sttRh — 0104-4i/.od :L'1ll U1 Vl1Ul-l-1Nc 4vQ
Cif or 104n Sale Zip Cale Flour To Fo mliollDescliption
C%m-_( o Y49 LZ—I
/urn retie,rimne number (�` Z r
4. DATE DRILLEDg•J7 06 Ss. XY6,
5. TOT-AL DEPTH! -?q<
6. DOGS WELL REPLACE EXISTINU WELL? YES U NO LUY
7. STATIC WATER LEVEL Dclow Top of Cnsiog: 15'._Ff.
(Uwe'V"If Alwve qop of Cnxbra) rn
g. TOI' OF CASING IS ( Vf. Above Lnud Sol race"
•lop of thing IrrtnlntdtJ nUor brlow lord trnlxte trqultrr a Lrl
nrlrure In ectorderee with ISA NCAC IC.011a. -
9. YIEI.D(gpm):—Lam_—MEf110001 'I'EST Ark
10.WATEIt ZONES(depth): j,QGQ�ION 5KI LC)j
Show ditecdon and distance In ndics from a((cast
12. CASING: Wnll'Ihk kness
11. DISINFECTION:Type p Amo li IS two State Roads or County Roads. Include die road
Depth Dinaleter or Wcighllrl. Material uuulbers slid conunon toad mmlics. 1
nom 0 To cia 1:(-IP..2c f�'DV21 P V —
Flom To FI.
riom To r(.
IJ. UROUT: Depul Mntelial Method
Fruit% 3' To�_11.� !wk 4`k
rrotrr_�Ta-,a,�'rt. fit► dl
14. SCREEN: Depth Diatuelef Slut Size Matednl
rtont To_rt- ln. In.
rtvm To__
15. SANDIGRAVEL PACK: ,o�tv%sartydllc
(7rPlh Size Mnterinl
Froth fo IT.
grunt 'Ib H.
16. REMARKS:
1 DO IICIkrBY CUMIFY T'IIAT-IIIIS WFLL WAS CONS"I'ItUCfED IN ACCORDANCE WITII 15ANCAC2C,WIr.LL
CONSTRUCTION STANDARDS.AND TIIAT A COPY OF THIS RE-CORD RAS BEEN PROVIDED TO TIW WELL OWNER
SIGNATURE OI'pL1ItSUN CONS'IRUCI'INU TIIE WELL DATE
Sulrndt the original to the DIVislo11 of 1Vater QuAlly,Grouudsvaler Sec11011, 1636 blall Service Coder-Italeigh,NC
27499-16J4 Thmtc Nu.(9I9)TJJ-J221,whhbl JU tiny+. OW-1 RLIV.07/2U01

NC UIVNIR II/ him
Qi t� `/
WELL CONSTRUCTION lU""XORD
Nor W Carolina-Dcpaitineul of&lvilounrcul nnJ Natural Resources-Division of Water Quality-atoundwaler Section
WELL CON TRACIOil(INDIVIDUAL)NAME tr lni) S m LA�)' soh CEIiTIFICAlION A C�
WELL CONTMCLOR COarrANY NAME IA),Iron (� r r I I t✓1a rIIONE a fCM ff3 -oC'sG.T
STATE WELL CONS rRUC11ON ITRA1110 ASSOCIATEll wQ rEMll'ta
(if npplirnblc) (If npplictible)
1. \PULL USE(Check Applicnble Ilux): Regidc"tinl Ir7/Muoicipal/Publ1c LI Industrial O Aglicullural
Monitoring El Recovery a 11cat Pump Woler hljeclion O Other O irodier,List Use
2. WELL LOCATION:
��� � " TUpogrnphielLmI selling
Neatest Cvun �e�ly.cAae-c OlUdge OSlope nllcy Mar1Z1a?saf �euse QA. (check.prrorrtnlebox)
(Suret N.nle,Number,Counnoutly,Subdivtrtot,Let No.,yip Cole) Latiludellongilude of well location
Y C
J. OWNGII�J�$vC In clad Oln 0KAeS (derleer/mtnuleahecend.)
Address Laliludellmigilude source:0017SO Fupoglapbtc"tap
(Ma!'1DLQ. (Stteel a Ilv to No. (check box)
IJ C P� Raw 1tLL11N_21 c)c�
city or town i Slate Vpcale From To Fo rwlionUcscription
Aire rode-rbnneninnber
4, DATE UI11LLl1D g-.29-OS �0' 145'
5. TO rAL DUrTN: /ifs' — -
6, DOGS WELL REPLACE LIXIS'rINO WELL? YES O NO W Cl
7. STATIC WATUR LEVEL Below Tolr Uf Cnsiag: 10 ' 1-r.
(Ure"+"Ir Abuve'I op orcming) Oy
8, TOP OF CASINO IS I 1"i'. Above I.nud Surface"
.Top or caging lerndnded.Uor below land.mimee repuheo a CI7
♦n Lnrt In Accordurce wllb ISA NCAC
9. YIELD(gpm): 160 ME'I'IIODOF'I'ESl'�rQ
10.WATER ZONES(del'Ill):
LOCATION SKE�CC11
11. DISINFECTION:Type Arnourd 1�. Show direction and distance In miles from at(cast
12. CASING: Wnli'iltickness two Slate Roads or Comely Roads. Include Ole wad
Ucplll Diameter or WeighuFl. Material numbers and conunon road itaincs.
From TO IDA, Fla e.35_ S�G21 �—
Flout To Fl. /K �
Fro"l To Fla
13. 0ROUT: Depill h atcrial Method �}j,`l
1'roD�_'ro_3_1't.
From 3' To moo' FL� �r t� G feek4d ?pertbuf�
14. SCREEN: UepUr Diameter Slot Size Matellid t2A
From To Ft.—Ill. lu.
Fivirt
15. SAND/ORAVIiI, PACK:
Depth Size Mntednl
Front ro FL , il4�,4
Fw"t 1'v FL
16. REMARKS:
1 DO I ICRHUY CERTIFY I IIAT'II IIS WULL WAS CONS"I RUCIED IN ACCOIUTANCE WITIf ISA NCAC 2C,WULL
CONSl RUCT IONS l"ANDARDS,AND TI IAT A COPY OF l I IIS RECORD I IAS BEEN PROVIDED TO V W WELL O WIIER
- � 9 ag_a-�c
SIUNA'IMEOFPIMSONCONS'IRUCfINUIl1EWELL DALE
Sub"dl Ille orlghlnl to the DlYlsluu of 1Yalcr Qunllty,Cruuadrvater Seclloll,16J6 blall Serdce Center-ItAleigli,NC
27699-1636 r Ito Dc No.[phone],liItIIIit 3U drys, OW-1 RLIV.U712UU1

WELL CONSTRUCTION RECORD
..•. - ,( A
North Cafolina-Department of Environment and N1,atund Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIV•lDUAL)TiAM6 (prloOslJP ri V7t$ ��f)Y3.n rl,°• tr,. .r(pIG(.ralD/Nf /�(P
WELL CONTRACTOR COMPANY NAM
STATE WELL CONSTRUCTION PERMhl - ASSOCIATRDW Illimm
(if applicable) (itappliable) -
I. WELL USE(Check Appliable Box):Raidatt'iatid�lrlun)cipaUPublic❑ Industrial❑ Agricultural
Monitoring❑ Recovery ❑` Heat Pump Water Injection❑ Other CJ If Other,List Use
2.-WELL LOCATION: 1 ttJLtiDd Selling
Nearest Town: 0 h: _ 1'>mpb g
County 7 tBRldge ❑Slope Malley Mist
L 6 u� e r- fYl'tV1 • -1e (eMelt appiopdata box)
(Suvxi Name,Number.Commvnily,Subdirisiat,l.a Wo.,Zip Code) L'atituilellongitude of w6II location
3. OWNER
Of, `102/ 1 • (degrxr)miputa/cooundr)
Address IQ I n •t 2 f/) M (illy, p ( Latitude/longitude source:❑GPS❑Topographic map
nn r (StreetorRawNo.) �{ C (eho*box)
K n�b r h CV he NC , ram! Si `77 DEM DRILLING LOG
Ciiybr Town State Zip Code .FromDescription To - Formation
C&O. 979 - 991 3 2.� _ � .
Area code-III numbern - -� "!
4. DATE DRILLED_ '! - ) 7 t)- -
5. TOTAL DEPTH: 5,5 n '
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Cuing:
(Uaa"e if Above Top arCadag)
8. TOP OF CASING IS�_FT.Above Land surface*
'Top of caring terminated atior belsvr Irmdauro=ragairb a
nrlaaco is accordance with ISA*UC 2C.0112. -
9. YIELD(gpm): Vj _METHOD OF T=
10.WATER ZONES(depth): S
' LOCATION SKETCH
It. DISINFECTION:,Type Atnotmt Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weightft numbers and-common road names.
From_Ti;_
From To Ft
From Tp Ft }
13. GROUT-• Depth Material Method. p
From
_1Z To
From—To, F .=.
t 3
.4. SCREEN: Depth Diameter . Slot size. • Materiel - - m
From To Ft--in, in.
0
t._in. in. .. cr1
5. SAND/GRAVEL PACK: _
Depth Size Material
From To Ft
From To Ft.
6. REMARKS:
DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 151k NCAC_2C,WELL
ONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HjjS BEEN P40VIDED TO THE WELL OWNER
7
SIGNATURE-OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Groundwater Section, Mail Service Center-Raleigh,NC
J7699-1636 Phone No.[phone],within 30 days. GW-I REV.072001 -`

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality " t
WELL CONTRACPOR(INDMIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PHONE 9 (&qA 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water I section❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:biutlpWV CounlyCHEROKEE Ridge []Slope ❑Valley ❑Flat
732 MOUNTAIN VIEW RD. (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: VIRGIL MCDOWELL (degrees/minutes/seconds)
Address 732 MOUNTAIN VIEW RD. LaBtudc/longitude source:❑CPS❑Topographic map
(Street or Rome No.)
±NUXmW-A NC 28906 DEPTH DRILLING(checkDRILLING LOG
City or Town State Zip Code From To Format on Description
(yA)-502-2889 V TO 20' RED/BROWN DIRT
Area code-Phone number 20'TO 40' BROWN DIRT
4. DATE DRILLED 09l29/05 40'TO 60' BROWN/TAN DIRT
5. TOTAL DEPTH: 205' 60'TO 77' BLUE GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 77-TO 205' GRANITE
7. STATIC WATER LEVEL Below Top of Casing: 50
(Use-+-if Alcove Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface* o
'Top of casing terminated aVor below land surface requires a -4
variance In accordance with 15A NCAC 2C.0118. i
9. YIELD(gpm): 6 METHOD OF TEST AIR
10. WATER ZONES(depth): 140'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers>arldcOmpiad ttames.
From U To 7r Ft. 6 118 SOR 21 PVC
From To Ft.
From TO Ft -
- i
13. GROUT: Depth Material Method j
From 0' To 20' FL CEMENT GRAVITY Rt`�7c From To FL 7 �60
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft.—mi . in.
15. SAND/GRAVEL PACK: °O
Depth Size Material
From To Ft.
From To Ft. `
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI1TI 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF 1T I1S RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIG ulUE OF Yl' ON CONSTRUCTING TIIE WELL DA--VE
Submit the original to the Division of Water Quality,Attn:Information Management, 1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD V_ ""
North Carolina Department of Environment and Natural Resources-Division of Water Quality y �, 4
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING 8 PUMP CO.INC. PHONE [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public ❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water lection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo raphic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge Slope ❑Valley ❑Flat
WILLOW TREE/FOX TROT WELL Q (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3501.951N 8409.833W
3. OWNER: RAY NEWCOMB (degrees/mimYYe''s/seconds)
Address 93 ROCKRIDGE RD. LaGtuddlongitudc source PS
map
(Street or Roule No.) /( heck box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
( 828)-837-7849 O'TO 20' BROWN DIRT
Area code-Phone number 20'TO 40' BROWN DIRT/BROWN SLATE
4. DATE DRILLED 09/23/05 40'TO 62' BROWN SLATE/BLUE SLATE
5. TOTAL DEPTH: 705' 62'TO 705' SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 75
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS I FT.Above Land Surface* C-+
•Top of casing terminated atlor below land surface requires a
valance in accordancewith 15A NCAC 2C.0118. Q�
9. YIELD(gpm): 314 METHOD OF TEST AIR c,
10. WATER ZONES(depth): u1
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Alitount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two Slate Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 62' Ft. 6 118 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' Ft.CEMENT GRAVITY
From To Ft. �01
14. SCREEN: Depth Diameter Slot Size Material / Q
From To Ft. in. in.
From To FL in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WM 115A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO IHE WELL OWNER
SIGNATURE OF PE NS' UCTING THE WELL ,DAIIH
Submit the original to the Division of Water Quality,Attn: Information Manag' cruc ,-M117 Mo Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD 61 .
North Carolina Department of Environment and Natural Resources-Division olf Water Quality
WELL CONTRACTOR(INDWIDUAL)NAME (prin[) WILLIAM BRADLEY LEWIS CERTIFICATION 03368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING 8 PUMP CO.INC. PHONE 9 pQp,)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
if applicable) (if applicable)
I. WELL USE(Check Applicable Box):Residenft[ MunicipaUPublic❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water njcclion❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo$rapIt' /Land setting
NearestTown:��i� County CHEROKEE ❑Ridge !lope ❑Valley ❑Flat
EBENEZER/ROSECREEK WELL341 ckappropriatebox)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3509.885N 8405.379W
3. OWNER: NEMECIOHERNANDEZ (degrees/mines/seconds)
Address 2900 NW 33RD.AVE. Latitidc/longitude source.AGPS❑TopograpWc map
(Street or Route No.) (check box)
MIAA11 FL 33142 DEPTH DRILLING LOG
City or Town state Zip Code From TO Formation Description
(30c�)-525-7575 0'TO10' RED SLATE
Area code-Phone number 1 O'TO 20' BLUE SLATE
4. DATE DRILLED 09/07/05 20'to 805' SLATE
5. TOTAL DEPTH: 805'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 200 0
(Use"+"if Above Top of Casing)-1 r.
8. TOP OF CASING IS t FT. Above Land Surface* t
*Top of casing terminated at/or below land surface requires a
valance In accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 1/6 METHOD OF TEST AIR �
10. WATER ZONES(depth):
LOCATION SKETCH
It. DISINFECTION:Type CHLORINE Amount too PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From U To 20' Ft. 6 118 SDR 21 PVC
From To Ft.
From Ft.
13. GROUT: De Depth Material Method
From 0' To 20' FL CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Malcrial
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
Frain To FL ` a
16. REMARKS:
I DO HEREBY CERTIFY THAT THUS 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
SJUNATURE OLPSON CONMRUCIING THE WELL bATr—
Submit the original to thebivision oliVVa�r'QuA tyj"it : information Mana"ent,'f414 Mail Service Center-
Raleigh,NC 27699-1617, Ohone N%49}Z33.70i15 vjA it 30 days
GW-I REV.09/2004
_ 4

WELL CONSTRUCTION RECORD O
North Carolina Department of Environment and Natural Resources-Division of Water Quality 61 I
WELL CONTRACrOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PHONE # 04i9N 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
11011100111111 (if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential � Municipal/Public ❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town:_�geN.� County CHEROKEE ❑Ridge 41SIope ❑Valley ❑Flat
EBENEZER/ROSE CREEK WELL#2 ( heck appropriate box)
(Street Name,Numbers,Community,Subdivision,L.ot No.,Zip Code) Latilude/longitude of well location
3509.915N 9405.405W
3. OWNER: NEMECIO HERNANDEZ (degrees/mimes/seconds)
Address 2900 NW 33RD.AVE Latitude/longitude source:I�IGPS❑Topographic map
(Street or Route No.) (check box)
MLEMI FL 33142 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
(;CE)-)- 525-7575 O'TO 20' FILL DIRT/SLATE/RED SLATE
Area code-Phone number 20'TO 60' TAN/BROWN SLATE MIX
4. DATE DRILLED 09/20/05 60'TO 80' BROWN SLATE TO BLUE SLATE
5. TOTAL DEPTH: 705' 80'TO 705' DARK BLUE SLATE-.
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 200 F F r r ,
(Use"+"if Above Top of Casing) rn
8. TOP OF CASING IS 1 FT. Above Land Surface'
*Top of casing terminated aUor belury land surface requires a l
variance in accordance with 15A NCAC 2C.0118. QF
9. YIELD(gpm): 116 METHOD OF TEST AIR
0
10. WATER ZONES(depth): 51 a
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 94' 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. Qwv
14. SCREEN: Depth Diameter Slot Sue Material t
From To Ft. in. in.
From To Ft. m. in. �r
15. SAND/GRAVEL PACK: ,(J
Depth Size Material `�/
From To Ft.
From To F[.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE Wl'l 115A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO 111E WELL OWNER
gla�l�
SIGNA IJRE OF P SON CONS RUCTING'IM WL'LL A'I
Submit the original to the Division of Water Quality,Attn:Information Managepte4t,1617,Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV. 09/2004

WELL CONSTRUCTION RECORD
k h ;_)
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prinQ WILLIAM BRADLEY LEWIS CERTIFICATION 013368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PHONE # CR;A 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water n ection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land settin
Nearest Town: MMaM County CHEROKEE ❑Ridge ❑Slope ❑Valley Flat
BOILING SPRINGS (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: WENDELL DANIEL (degrees/minutes/seconds)
Address 7952 WEST RIVERBEND RD. Latitude/longitude source:❑GPSOTopographic map
r,, (Street or Route No.) (check box)
N�TAL pryFiL FL 34428 DEPTH DRILLING LOG
City or Town State Zip Code From TO Formation Description
795-5438 V TO 20' BLACKIBROWN DIRT
Area code-Phone number 20'TO 35' BLUE/GRAY GRANITE
4. DATE DRILLED 09/27/05 35'TO 205' GRANITE
5. TOTAL DEPTH: 205'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO }
7. STATIC WATER LEVEL Below Top of Casing: 50
(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 require a
variance in accordancewnh 15A NCAC 2C.011& m
9. YIELD(gpm): 12 METHOD OF TEST AIR o
10. WATER ZONES(depth): 180' 2W cn
LOCATION SKETCH ti
11. DISINFECTION:Type CHLORINE Amount too PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or WeighUrt. Material numbers and common road names.
Fmm 0' To 35' FL 6 1/8 SDR 21 PVC
From To F[.
From To Ft.
13. GROUT: Depth Material McUtod —�
From 0' To 20' Ft.CEMENT GRAVITY
Fro
"I To FL ^%
14. SCREEN: Depth Diameter Slot Size Material ('„
From TO Ft. in. in.
From To—Ft. in. in.
15. SAND/GRAVEL PACK: v�
Depth Size Material
From To FL
From To Ft.
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
-bju -Amj�a q ei o gl 7 t)
SIGNATURE OF P ON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (prlat) JOHN ARTHUR CHASTAIN CERTIFICATION#3401
WELL CONTRACTORCOMPANY NAME CHEROKEE WELL DRILLING$PUMP CO.INC. PnONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
i. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water ction❑ Other❑ If Other,List Use
2. WELL LOCATION: sL Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE IplRidge ❑Slope []Valley ❑Flat
SOARING EAGLE ! (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: BOB FARVER (degrees/minutes/seconds)
Address PO BOX 151 Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28 )-837-0185 0'TO 18' FILL DIRT
Area code-Phone number 18'TO35' BROWN DIRT
4. DATE DRILLED 09/06/05 35'TO 55' BROWN DIRT 8 GRANITE
5. TOTAL DEPTH: 805' 55'TO 66' GRANITE/SET CASING
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 66'TO 805' GRANITE
7. STATIC WATER LEVEL Below Top of Casing: 500
(Use"+"if Above Top of Casing) „s
8. TOP OF CASING IS 1 FT.Above Land Surface' t^
in r
*Top of casing terminated aUor below land surface requires a
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 4 3/4 METHOD OF TEST AIR U1
10. WATER ZONES(depth): 480'8 765' r,
LOCATION SKETCH is
11. DISINFECTION:Type CHLORINE Amount too PPM Show direction and distance in miles from at least,y
12. CASING: Wall Thiclmesa two State Roads or County Roads.Include the road
Depth Diameter or weight/Ft. Material numbers and common road
namas—
From 0' To W Ft. 61/8 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' FL CEMENT GRAVITY
From To Ft. ee
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. 111. in
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: BROKE SIT
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
CONS
Tj�
SIGNATURE OF PERSON�NS RUCTAIG THE WELL DATE'
Submit l
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center. C,
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004 `=

WELL CONSTRUCTION RECORD 6) is 4
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION 3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PHONE # &JR)837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
00111111111111
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial ❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water 1jection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MuRPHl County CHEROKEE I�Ridge ❑Slope ❑Valley ❑Flat
GRAPE CREEK RD. / t (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3508.995N 8406.682W
3. OWNER: TAYLOR HANSON (degrees/minutes/seconds)
Address PO BOX ion Latitude/longitude source: GPS❑Topographic map
(Stint or Rome No.) ( heck box)
MILLEDCIEgILLE GA 31059 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
d(�-444-9290 0'TO 20' BROWN DIRT SAND
Area code-Phone number 20'TO 80' TAN DIRT
4. DATE DRILLED 08/31/05 80'TO 585' GRANITE
5. TOTAL DEPTH: 585'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 100
(Use"+"if Above Top of Casing) 'n
S. TOP OF CASING IS 1 FT.Above Land Surface* —
-Top of casing terminated attor below land surface requires a
variance In accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 1/2 METHOD OF TEST AIR 1n
y
10. WATER ZONES(depth): o
LOCATION SKETCH a
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at leaspi
12. CASING: Wall Thickness two State Roads or County Roads. Include lire road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 99 FL 6 118 SDR 21 PVC
From To Ft.
From To FL
13. GROUT: Depth Material Mcihod
From O' To 20' FL CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Sue Material 4{{
From To Ft. in. in.
From To Ft. in. in. r
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
0
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITI 115A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PEWSON CONSTRUCTING THE WELL .
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
0 -1 u u 6 U
North Carolina Department of Environment and Natural Resources-Division of Water Quality
wELLcoNTRAcroR(jNDivIDuAL)NAME (print) JOHN ARTHUR CHASTAIN CERTIFICATION 113401
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING 8 PUMP CO.INC PHONE # [phone]
STATE WELL CONSTRUCTION PERMTT# ASSOCIATED WQ PERMTT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Watertection❑ Other❑ If Other,List Use
2. WELL LOCATION: Top o�zaphic/Land setting
Nearest Town:_7� COI CHEROKEE ❑Ridge pQSlope ❑Valley ❑Flat
1057 CANYON D. ( h k appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) LatitudeAongitude of well location
3507.641N 8355.686W
3. OWNER: KEN LOVINGOOD (degrees/ t(�/seconds)
Address 406 LONG BRANCH RD. Latitude/longitude source: GPS❑Topographic map
(Street or Route No.) /(c eck box)
NC 28905 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8( 28)-837-0997 0'TO 20' BROWN DIRT
Area code-Phone number 20'TO 60' RED DIRT
4. DATE DRILLED 08/16/2005 60'TO 80' SLATE GRANITE/SET CASING
5. TOTAL DEPTH: 225' 80'TO 225' SLATE GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 50 y
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT.Above Land Surface* c
-Top of casing terminated War below land surface requires a
variance in accordance with I5A NCAC 2C.Olt8. py
9. YIELD(gpm): 10 METHOD OF TEST AIR �o
10. WATER ZONES(depth): 190' Ga
LOCATION SKETCH cn
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include thJ road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 8V 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 7� J
From To Ft. in. in. J
From To Ft. in in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft. T
From To Ft.
16. REMARKS: U
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
Y) 1�
4 �' � nQrir�, ;
NATURE OF PERSON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004

WELL CONSTRUCTION RECORD r
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PHONE # (Ec' )837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 1 MumcipaUPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: Mu0.P County CHEROKEE ❑Ridge []Slope Valley ❑Flat
CLATE FAIN RD. (checkapprop etebox)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: BENJAMIN TRAMMELL (degrees/minutes/seconds)
Address 450 DEER RIDGE TRAIL Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
ruF � yZ GA 30522 DEPTH DRILLING LOG
City or Town state Zip code From To Formation Description
y In-889-1521 0'TO 20' RED DIRT
Area code-Phone number 20'TO 40' TAN&BROWN SLATE MIX
4. DATE DRILLED 08/19/05 40'TO 74' DARK BLUE SLATE
5. TOTAL DEPTH: 605' 74'TO 605' GRANITE -A
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 250
(Use"+"if Above Top of Casing) G s
8. TOP OF CASING IS 1 FT.Above Land Surface*
`Top of easing terminated at/or below lend surface requires a --
variance in accordance with 15A NCAC 2C.0118.
9. YIELD(gpm): 1/5 METHOD OF TEST AIR O
10.WATER ZONES(depth):
LOCATION SKETCH ,
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at IcAt
12. CASING: Wall Thickness two State Roads or County Roads. lude the road
Depth Diameter or Weight/Ft. Material numbers and common ro S.
From 0' To 74' Ft. 6 118 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. r
From To Ft. in in /—(�L/l
15. SAND/GRAVEL PACK:
Depth Size Material �t
From To Ft.
From To Ft.
16. REMARKS: [0 1 5
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
SIGNATtRE OF PER!5WCONSTRUCTING THE WELL DAM
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD r�� � JL v s 4
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring ❑ Recovery ❑ Heat Pump Water ection❑ Other❑ If Other,List Use
2. WELL LOCATION: T hc/LLind settingi
Con CHEROKEE lope ❑Valley ❑FlatNearest Town:MUQONY g(
CLATE FAIN RD
k appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: BENJAMIN TRAMMELL (degrees/minutes/seconds)
Address 450 DEER RIDGE TRAIL Latitude/longitude source:❑GPS❑Topographic map
(Street or Rouse No.) (check box)
CBERIM LLY� GA 30522 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
(ID(p)-889-1521 V TO 10' RED DIRT
Area code-Phone number 10'TO 30' SOFT BROWN SLATE
4. DATE DRILLED 08/23/05 30'TO 45' BROWN&BLUE SLATE MIX
5. TOTAL DEPTH: 245' 45'TO 58' BLUE SLATE -
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 58'TO 245' SLATE
7. STATIC WATER LEVEL Below Top of Casing: 75
(Use"+"if Above Top of Casing) -
S. TOP OF CASING IS 1 FT. Above Land Surface*
-Top of casing terminated nVor below land surface requires a N
variance In accordance with 15A NCAC 2C.011& t9 "=
9. YIELD(gpm): 30 METHOD OF TEST AIR
10. WATER ZONES(depth): 220' BIT SIZE 5.990
240' LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at lust
12. CASING: Wall Thickness two State Roads or County Roads.Include die road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 58' Ft. 6 118 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 71--
Fmm TO Ft. in. in. f
From To Ft. in. in. L
15. SAND/GRAVEL PACK: J
Depth Size Material
From To Ft. C ^BCD
From-To-Ft.
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 TI tIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PL'RCO STRUC' NG THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mall Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
� aEpU 4 el
North Carolina.Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACfOR(INDIVIDUAL)NAME (print) JOHN ART HUR CHASTAIN CERTIFICATION#3401
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING$PUMP CO. INC. PHONE # [phone]
STATE WELL CONSfRUCfION PERMTr# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential MumcipaWablic❑ Industrial❑ Agricultural❑
Monitoring ElRecovery ❑ Heat Pump Water In ection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topo�$raphic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge IpSIC ❑Valley ❑Flat
SUNNY POINT RD. ( h kappropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: PETE JOHNSON (degrees/minutes/seconds)
Address 2480 SUNNY POINT RD. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
8L28 )-644-9254 0'TO 2' TOP SOIL
Area code-Phone number 2'TO36' YELLOW CLAY
4. DATE DRILLED 08/23/05 36'TO 445' GRAY GRANITE
5. TOTAL DEPTH: 445' =1
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO
7. STATIC WATER LEVEL Below Top of Casing: 0 e
(Use"+"if Above Top of Casing) C
8. TOP OF CASING IS 1 FT.Above Land Surface* EFa i
-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 rt
10. WATER ZONES (depth):
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at leas(
12. CASING: Wall Thickness two State Roads or County Roads. Include th road
Depth Diameter or Weight/Ft. Material numbers and common mad names.
From 0' To W Ft. 61/8 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method Nj
From 0' To W Ft.CEMENT GRAVITY s
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS'AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OPTER SON CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn,.Information Management,161TBUH Service Center-
Raleigh,NC 27699-1617, Phone No. [phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD U
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACrOR(INDIVIDUAL)NAME (prYul) JOIN ARTHUR CHASTAIN CERTIFICATION$13401
WELL cONTRACrORCOMPANY NAME CHEROKEE WELL DRILLING 8 PUMP CO.INC PHONE # gM 837-8008
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water ection❑ Other❑ If Other,List Use `I
2. WELL LOCATION: Topo$raphic/Land setting
Nearest Town:��pp1l�County CHEROKEE pRidge A1Slope ❑Valley Qglat
RAPER MILL CREEK check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Lautude/longitude of well locator ,
3500.428N 8408.683W c.I1
3. OWNER: PAT PALAZZOLO (degrees/min s/seconds) ;
Address 110 HALF MOON CIRCLE Latitude/longitude source GPS❑Topographic'i'nap
(Street or Rome No.) /( eck box)
NypOLUXn FL 33462 DEPTH DRILLING LOG
City or Town State Zip Code From To Formation Description
C5(o )_ 586-7445 O'TO 20' RED DIRT
Area code-Phone number 20'TO 40' BROWN DIRT
4, DATE DRILLED 08/15/05 40'TO 60' YELLOW DIRT
5. TOTAL DEPTH: 345' 60'TO 80' RED DIRT
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 80'TO 140' BROWN DIRT
7. STATIC WATER LEVEL Below Top of Casing: 75' 140'TO 166' GRANITE/SET CASING
(Use"+"if Above Top of Casing) 166'TO 345' GRANITE
8. TOP OF CASING IS 1' FT. Above Land Surface*
-Top of casing terminated at/or below land surface requires a
variance in accordancewith 15A NCAC 2C.0118.
9. YIELD(gpm): 50 METHOD OF TEST AIR
10.WATER ZONES(depth): 220'
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 166' Ft. 61/8 SDR 21 PVC
From To FL
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' Ft.CONCRETE GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Mate al
From To Ft. in. in n I I �rV
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS: Nvq
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
SIGNATURE OF PERSON CONSTRUCTING TEE WELL 'IJAIE
Submit the original to the Division of Water Quality,Attn: Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and N-a,;t)ur1al Resources-Division of Water Quality-Groundwater Section
WELL CONTRACTOR(INDIYIDUAL)NAME ((pririnty)../"lSC:NZ P. V/C7t7R CERTIFICATION#,3/7�
WELL CONTRACTOR COMPANY NAME /3c e; 60ee ,' �QRJ /;N& —rj,(C PHONE # ,(7475�
STATE WELL CONSTRUCTION PERMIT# AtOCIATED WQ PERMIT#
if licable ifapplicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agriculttital❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: /�Topoglaphie/Land setting
Nearest Town: I "V Rt�F{Y ( 1 C County 2 CEE Ridge ❑Slope ❑Valley ❑Flat
Sc/o(,, (d=k Opproprude box)
(Street Name,Numbers,Community,subdivision,Im No,Tip code) LatitudeAongittidp of wo11 iopnon ;
3. OWNER: lL /AM I�IIZSGN �/3.s (�2.5/.3 /.JO�sy08- CR Z 2
Address �i544 FJBTraN POINTRL7 (de�n°n;ue�aSaomaa)
Latitude/longitude source:6GPS❑Topogtaphicmap
(Street or Route NoJ (check box)
P3703 DEPTH DRILLING LOG
City or town 9 Form
zip Code F% 3 ation Description
27>? yt�[a&J clay
Area ado-Phone�m _ f O(7�N6E CL?r/4. DATE DRILLED '{g-C�5 �7�"-2
5. TOTAL DEPTH: 22 �} qg 62�Y-32a�N A✓6. DOES WELL REPLACE EXISTING WELL? YES❑ NO /{4 S( 6PEEr._t3��nl ea z
7. STATIC WATER LEVEL Below Top of Casing:_�FT. 5( l 1 G22Y SCA
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS w 2-FT.Above Land Surface' 1 Ito-3 I�f
I G 9(?
'TOP of ins termieated at1w below land surface requires a SC.^e
variance le aemrdmct with ISA NCAC 2C.0118.
9. YIELD(gpm): 20 METHOD OF TEST / _ 2_19 2 2 S SL 2Tt-
10.WATER ZONES(depth): 'Sion M a i k I SM
LOCATION SKEI H
11. DISINFECTION:Type TF/ Amount $ O Z Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads,Include the road
Depth Diameter or Weight/Ft Material numbers and common road names.
From_Q_T0_1:a_Ft (o V4 SDR27.5 YC
From y4 To (oy Ft b YS SDK 2/ /�YG
From To Ft_
13. GROUT: Depth Material Method '
Prom To�S _Ft. ce lle;jr- R2V/fY -
FromCn
To Ft m
14. SCREEN: Depth Diameter Slot Size Material -v
From To Ft in. in. i
From To Ft. in. in. CD
15. SAND/GRAVEL PACK: rr
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL .-
CONSTRUCr STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL OWNER
LTV v SIGNATURE OF PERSON CONSTRUCTING THE WELL
DATE
Submit the original to the Division of Water Quality,Groundwater Section,1636 Mail Service Center-Raleigh,NC
27699-1636 Phone No.[phone],within 30 days. GW-I REV.07/2001

tic L_-- 011711lt --- Inru
WELL CONSTRUCTION IMCORD
Not III Cam I ina-Depaitnlcul of Lnvitowncul nud Nniulal Resoulces-Division of Water Quality-a[oundwater Section
WELL CON nAI'f oil(INUIVIUUAL)NAME (Inlnl) )CAYYX c P ttl.<<na CEIt IIFICA11ONaa7yVy
It'ELLCONrMCtortCOMPANI'NAAIE IM LIOC Ww Al df 11• r,0. ruunE e fvwa -2221
STATE%%ELI,CONS IIIUCIION I'EMtllo ASSOCIATED WQ rEaA1110 .
(ifnlplicnllr) _ (if nppllcnlrle)
Its
I. 1t•E1-1-USE(Check Applicnirle [lox): Residrulinl Ij/Muulcipul/PUI,Ilc U Induellial U Agiiculluial U
Munitol iog U Recovely U llcal Pump Water tlljeclluu U Other U If Other,Llsl Use
2. WELL LOCATION: Topogi-njildell,mid setting
NcaleslTownt�lyC CuuutyCl,ernk�o UIUJgc pc UV ell UILAW�_-�In1L' n I 1 I!�_ t NP k--C(X A (chec4 epprrhnlnie )bell)
(Surd Nnnw,Nu ubae,Cenmmuei y.SubdMolou,Lot No.,711,Cale) La111udeJ10I191lude Of well Iuea11011
J, 01VNE1(: I\0 1fli � �Tww�1�_— (drprerNlninmre tecnndr)
Address Laliludellougilude source:EJGPSO7-upoglnphic nwp
(Sued a It No.) (ehetk box)
II F� 3760 P-Mu M LLNII LU4
1 I- S VI �—
CilyorlbWn Sul. Zip Cale h10n111 I.O ryfinatiou Descrij, iuil
r — f7 l�
Alrre—rnlr-rhene niee b.r -,j2t — I lO
4, UA"IF• DRILLED
5. 1*0 I'AL DEI•TI I' n��r
6. DOES WELL REPLACE EXISTINO WLLL7 YES U NO L7-
7. STA"fIC1VA'fEIILLVELUcIow'fopufCasiug r7�_hl'.
(U.e-f-If Above Tap of CMi.btr) rrl -
8. 701' OF CASINO IS l_ . Vf.Above Lnud Sull'ace" ,
•"top at taller Irindn.lrd Miller btlow IMind sut Otte rrliuhn■ .I -
nll.nte In acterds,te with 15A NCAC 7C.0110.
9. YIELD(gpm):C_MULIOD O ITS I' u,
10.WATER ZONES (dcplh): WCAION SftU-0L
11. DISINPECIlON:Type. Antoulit l Show direction and distance in Miles f/o111 a1 least
12. CASINO: Wnll"Ilticknrss two Slate Roads or Couuly Reeds. loclude We road
Dcptli Uimucicr or WeighVl°I. Malcdal Ituuibels and common toad lmmcs.
i"tout f� Iu -1'1 _ i —
M��Nay
Flom_ Te ft• es/dd
feel„ Tn fl.
13. OROU7: Depth Msleiisl Method
1'10111 a TO�?b=1-1.�r 1
Flanl_�_To_
14. SCREEN: Deptt Dimucicr Slut Size Malellnl
Flout To 17t. in. In.
fronl -lo__fl. iu,
15. SANDIGI(AVI°I, PACK:
UrpUl Size hinlci lnl crcS¢
floral_ fo Ft.
flout
16. REMAMS:
I DO I IIII(EUY CERTIFY I IIAT-II IIS WELL WAS CONS rRUCI ED IN ACCORDANCL WITII I5A NCAC 2C,WLLI.
CONS I I(UCIION S FANDAIU)S,AND'lIIAl'A CWPY 01:I"I HIS ILL'CORD IIAS ULLN pROVIDLU TO TI IL MILL OWNER
SIGNAIUIIL Ul'I l!I(SUN CONSI It UI l'INO TIIE WELL UATL 1
SUI)IIIII the orlglnnl (u the Dlvitlou of Water Qunlhy,Groundwater Secdoll,1636 Al il Service Center-Italelgh,NC j
17699-16J6rhmicNo.[phone],vtltllbl311Jnps, OW-1 REV.07)2001

tic ✓ 01V'NER -_ l HIN) _
WELL CONSTRUCTION RECORtD
Nottl Cmoliva-DCpal Imcul of Ellvilouutcut and Nnluial Resources-Divisioll of Water Quality-Oroundwalcr Section
WELL CON-IMCI Oil(INDIVIDUAL)NAME Qn``Inp )O`^AOSJ �1 • I1-� , CEIIUFICAIIUNIP520 {
tt'ELLCONTRACIOIl CUa1PANVNAI%I �fLi•�lOt n,J ,1 (If+1i�Q PIIUNE / fret, (537-2Y4
STATE WELL CONS I"UCIION 1•EMII M ASSOCIATED WQ PF-RPIIII
(if npI licnl IC) (If npplicnblC) _
1, \I'GLI. USE(Check Applicable Ilun): Ite0dowiul W-Mu dcipnl/Public U Irrllusl,lnl U Aglicullulal
Pfuuitoiing CI Recovery U 11ce1 I'uugt Willer Injectioll❑ Other U If Older,List Use
2. W ELI. LOCH"PION: ( 'fopogrnphiJLnnd scltiug
Ncnres ��CuuulY� � pY UWdgo 155foPc EIVnIleY UPlal
(ceck h q•pt opd bri.)
ele bow)
(Street Nenm,Nmn1•ne,Cononuntly,Subdiririon,Lot No.,Zip C,Ae) 1-aliluddlongilude orwCll Ioeaboll
3. OWNER: `T1 IVI -j-Q 13 (depreee/ndnmet recmnl.)
Address _1 r1_ fr r rl dS h Lb u rt Laliludellougilude source:UOPSUI'upugfMillie nwip
(Street or Route Flo.) (ebttk tore)
/1�u r n i, z�f906 Im,111 MULLINU_LQU
Citytyorio Ic zq,Cate Fluor To Fon,nitouDesclipliou
In —
Art(—�rcJe-rbone uinnber / 2 �S '
a. DAIGDRILLED u- LJ -GS � < —ISE
5. TG 'AL D 'I'-I-IP '
G. DOGS WELL REPLACE FXISFI140 WFLL7 YES U NO LL
7. STATIC WM 1 1(LEVEL Dclow Top orCMsing:--O-S� rf-
(Ure"+"Ir Above l-pof Cneh1p) C/3 1'
8, TOI' OF CASING IS I 1T.Abovc Land Sutrace• Z)
•I up of e•tlnr,Irnnlnattd.Uur below lunl nuf.te eequher• I t'_:
eaten<e In eccordmace wllh 15A NCAC IC-Ol IN. 71
9. YIELD(gpul):_L%a _MIA,110131 OF 7 FST,61'a o
10.WATEII, z0NFS (dgrth): 6cl
1.SZG1ITI.4N�KIiLC1L
Show direction and distance in miles Olnn at least
1 I. C S CASING:
"ION:'1 ypch e Anl I hic /� two Stale Roads or County Roads. Include We load
12. CASING: Wnlllhickness
Dcptll Dinulcler or Wcighurl. MaletiMl nwnbers and contnlon road"allies.
Front U 'I o-a6L I`t•�p - -.S�Ce2-/ D✓�
root To rl.
rrom To rl.
Id. GROUT: Depth D1nktinl / Method
I'Imn--� — I'oy� _Iel. ✓
14. SCIIE-EN: Depu1 Dialnleler Slot Site matelini G/u/�/' welt
Honk
rtout_ ro _ —rl, ln, iu. 1,�
15. SAND/GI(AVI?LPACK: y(ien�S�;�1 CAu�c/ XCI
Dq,tl1 Size Mnlsinl
rmnt I'o FL
I'rmu 'Ib Fl.
29
16. RL•PIAMS:
I DO NFttEDY CElt riFY TI IAT'1111S WELL WAS CONslltt)CIItD IN ACCORDANCE WITII 15A NCAC 2C,WELL
CONS"f 1=1 ION STANDAIWS,AND'I I IA r A COPY OIf'11IIS ItLCORU I IAS BEEN PROVIDEU TO TI IL WELL OWNER
SIGNAIUI(IS OF I'ERSUN CONS'IRUCI1NU 111E WELL DAIS
Submit 111e of iglnnl to the Dlvislon of Water Qunllly,Gruuudlralel-Sectlour 1636 MallServlce CUI�r,Raleigh,C
17699-1636 rllone No.(919)7Jd-d221,1111hb1 JU da)•n.

tic MINER --------- anru
------- ———————
WELL CONSTRUCTION aiEco1iU z
Nola,Carolina-Depathnent of Ltnvitoumenl mtd Natural Resources-Divislol,of Water Quality-Utoundwaler Seclii� ''rr
on�� �
WELL CUNT RACfUIr(IN VIVID UAL)NAM E Qn hd) 1CApjf2S ? h�l LSt>✓{ CEItI1FICA71UNa uu�y-
11'EI.LCONIHAC1UILCOMPANYNAME Yh�IIC-r rl(-#(I nU PHONE a ffsh4]RS1—�G�7
STATE WELL cONSfRUCIION 1'EMIIIM A5SUCIA-1 Ell%VQ PFRAIr10
(if nl•plirnbic) (If applicable) -
nna
I, 1VIiL1,USE (Check Applicable Ilan): Ilcsidcaliul Bl�hluuicipol/Public U Induahisl U Agiicultutsl
Mmlituling U Recovery U Neal Pump Water Injection U Other U If Odier,List Use
2. WELI,LOCA'IION: 7bpogtnphil/1-nnd selling
Ncalcst'fvrvn: Lvuuly-C Veshke _ LD}t3Jga USlvpe Ca.y Ullat
--� (chest,PPro,nlnle.te bnq
js e J( — ------ -- LntiluJdlongilude of well location
(Snrar N.�nr,Nmnberr,Cnmuomnily Sn�� olluo,Lai No.,7.i1,CA-le)
3. O1VNElt: ,� (depiten/rnlnolrJeecnml.)
Q Li Latilude/longilude source:UOPSUTvpogtnphic otap
AJJicss —3 --�Jqy� (chart bo.)
(�Sn�ect�m Houle Nu.)
—� ] i" V`- HOC 1) 'L(''►'ll U1�ILI.It�c7 ► VU
City or lac+.n 5tae Zq,Code Motu '1'u I'o�nlalim,Ucsa iplivu
(-- ) __ If
Art,rule-I'linne ninnbcf - '
4. DA'rIi DRILLED—'?)- I la 0,5 4o, e1.731 C- (rci r'1 i P
5. TOI'AL DEVI W q-p
6, DOES 1VELL IIEI'LACR EMS"I NO WELL') YES U 140 W
7. SI'A-IIC WAI EIL LEVEL Dclow'Ibp of Cnsiug' • _I-1'.
(Ole-r"If Above'1 ol,of C,atinn)
8. TOP 01:CASING IS I I"I'. Above Lmtd Silllocc•
•ToP of tninr Ienolo.led.Uor bel.w lanl nur.re tegnhr,a
r,tl,nrt In accordance with 15A NCAC IC.0118,9. YII!LD((!pill): t�METHOD OF•►LSI,Ade
IU.WATEIt ZONES(depih): WCA•LION S(C►:(M
Show direction and distance in miles Gmn at IeaSI
II. DISINFECI'ION:'fypeh l 5 Anwmit lh two Slate Roads or County Roads. Include We road a+r
12. CASING: Wnlig kness
DcpU, Dinumicr of We WcighUhl. Malnia{ numbers wad conunou road nootcs.
Front To Ft.
rion, Tu F►.__
13. 0ROUF: Depot Ni letia — McWoJ
doll D Tom_1:1•
Flom_=�I� rl_o
14. SCREEN: Depol Uiaveter Slot Size Matelial
Ftvu( ry rt. in. in. rr i
rival To-- 1. In. In. o
15. SAND/GRAVEL PACK: t
Depth Size Mnlnlnl v
From Tn Ft. C." t
rtom �
16. REMARRS:
I DO I IFIIEDY CHI(TIFY TI IAT'I INS WELL WAS CONS'IRIICII?D IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS I MCI IONS[ANDARDS,AND THAT A COPY OF-I I IIS RECORD IIAS BEEN PROVIDED TO THE WELL OWNER
' SIUNA'IUIIEUFI'EIISUNCUN5'IIIUCfINU711LWLLL DAIL
Submit the of iglnal to lbe MY131on of Water(luniily,Groundwater Sectimi,1636 Mall Service CUIiffW!I ►tLVgU1l2UUl
27699-1636 (hone No.[phone],nithhl 3U flays.

WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR(INDIVTDUAL)NAME (prMt) WILLIAM BRADLLY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING 8 PUMP CO.INC. PHONE # [phone]
STATE WELL CONSTRUCTION PERMTT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Municipal/Public❑ Industrial❑ Agricultural❑
❑Monitoring❑ Recovery Heat Pump Water ection❑ Other❑ If Other,List Use
2. WELL LOCATION: T To phic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge lope ❑Valley ❑Flat
SIMONDS CHAPEL RD. heck appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: DAVID CURTIS (degrees/rainutes/seconds)
Address 186 CLATE FAIN RD. Latitude/longitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town state Zip Code From To Formation Description
8( 28 )-494-5522 0'TO 10' BLACK DIRT
Area code-Phone number 10'TO 20' BLACKIRED DIRT
4. DATE DRILLED 08/22/05 20'TO 40' DIRT/GRAVEL
5. TOTAL DEPTH: 365' 40'TO 65' DARK BLUE SLATE`-'
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO 65'70 365' SLATE
7. STATIC WATER LEVEL Below Top of Casing: 50
(Use"+"if Above Top of Casing) y�r1
8. TOP OF CASING IS 1 FT. Above Land Surface"
*Top of casing terminated Wer below land surface requines a J J
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 30 METHOD OF TEST AIR L
10.WATER ZONES(depth): 360' LS
LOCATION SKETCH
. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least"
12. CASING: Wall Thickness
two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers common road names.
From 0' To 66 Ft. 61/8 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 20' FL 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 t<
From To Ft.
From To Ft.
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
4- /&
SIGNAL OF PERS2'VUONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD
4✓North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACfORg"IVIDUAL)NAME (print) WILLIAM BRADLEY LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO PHONE # [phone]
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMrr#
MENNEN (if applicable) IMMUNE (if applicable)
1. WELL USE(Check Applicable BOX):Residential MunicipaLftblic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water lection❑ Other❑ If Other,List Use
2. WELL LOCATION:
Nearest Town; MURPHY County CHEROKEE Topographic/Land Setting
HEMBREE RD. Ridge ❑Slope ❑Valley ❑Flat
(Street Name,Numbers,Community,Subdivisioq Lot No.,Zip Code) (check appropriate box)
LatimdcAongitude of well location
3. OWNER: DON DECKER
Address 642 MCCOMBS RD. (degrees/minutes/seconds)
Latitude/longitude source:❑GPS❑Topographic map
(Street or Rome No.) (check box)
MURPHY NC 28906 DEPTH 0'TO 2 DRILLING LOG
8( )-837-5420 0'
City or Town State Zip Code From TO Formation Description
Areaa c code-Phone number BROWN DIRT
4. DATE DRILLED 08/25/05 20'TO 40' BROWN DIRT/BLUE SLATE
5. TOTAL DEPTH; 605' 40'TO 60' BLUE SLATE
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO4. 60'TO 605' SLATE
7. STATIC WATER LEVEL Below Top of Casing: 150
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS 1 FT. Above Land Surface*
'Top of casing terminated aVor below land surface requires a
variance in accordance with 15A NCAC 2C.011&
9. YIELD(gpm): 10 METHOD OF TEST AIR
10. WATER ZONES(depth): 58o'
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads. Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 69 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: th
Dep Diameter Slot Size Material =-a
From To Ft. irL
From To m.
Ft. in. in-
15. SAND/GRAVEL PACK: IlQppppV r,-r
From ODepthpth Size Material t�eYee
Ft.
From To Ft-
CD >=
16. REMARKS; cn
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
l D/ruin e7 �a�Oo
SIGNATURE OFF ° N CONSTRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attu;Information Managenteut,
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days 1617 Mail Service Center-
GW-1 REV.09/2004

WELL CONSTRUCTION RECORD s '
North Carolina Department of Envaonment and Natural Resources-Division of Water Quality
WELLCONTRACTOR(INDIVIDUAL)NAME (print) WILLIAM BRADLL-Y LEWIS CERTIFICATION#3368
WELL CONTRACTOR COMPANY NAME CHEROKEE WELL DRILLING&PUMP CO.INC. PFIONE # [phone] -
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential Mumcipal/Public ElIndustrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water njection❑ Other❑ If Other,List Use
2. WELL LOCATION: Topographic/Land setting
Nearest Town: MURPHY County CHEROKEE ❑Ridge ❑Slope ❑Valley ❑Flat
HEMBREE RD. (check appropriate box)
(Street Name,Numbers,Community,Subdivision,Lot No.,Zip Code) Latitude/longitude of well location
3. OWNER: DON DECKER (degrees/minutes/seconds)
Address 642 MCCOMBS RD. Latitudellongitude source:❑GPS❑Topographic map
(Street or Route No.) (check box)
MURPHY NC 28906 DEPTH DRILLING LOG
City or Town State Zip code From TO Formation Description
8( 28 )-837-5420 0'TO 3' FILL DIRT
Area code-Phone number TTO15' SAND GRAVEL
4. DATE DRILLED 08131/05 15'TO 30' LIGHT BLUE SLATE
5. TOTAL DEPTH: 675' 30'TO 180' BLUE GRANITE
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO 180'TO 520' WHITE QUARTZ
7. STATIC WATER LEVEL Below Top of Casing: 20 if j 520'TO 675' GRANITE
(Use-+"if Above Top of Casing)
8. TOP OF CASING IS I FT.Above Land Surface*
*Top of casing terndnaled at/or helm land surface requires a
vartance in accordance whh 15A NCAC 2C-.0118.
9. YIELD(gpm): 1 METHOD OF TEST AIR
10. WATER ZONES(depth):
LOCATION SKETCH
11. DISINFECTION:Type CHLORINE Amount 100 PPM Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include the road
Depth Diameter or Weight/Ft. Material numbers and common road names.
From 0' To 30' Ft. 6 1/8 SDR 21 PVC
From To Ft.
From To Ft.
13. GROUT: Depth Material Method
From 0' To 29 FL CEMENT GRAVITY
From To Ft.
14. SCREEN: Depth Diameter Slot Size Material y ,`emote
From To Ft. in in. r
From To FL in. in r�
15. SAND/GRAVEL PACK:
Depth Size Material Q i
From To Ft. (�
From To FL
16. REMARKS:AFTER 1W,HARD BLUE GRANITE&WHITE GRAY OUARTZ ---------------
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONSTRUCTION STANDARDS,AND THAT A COPY OF 11 US RECORD HAS BEEN PROVIDED TO THE WELL OWNER
Dl{1/)1 /h AQ L ai r� ��(p���ISLL
J �
SIGNATURE OF P NS IRUCTING THE WELL DATE
Submit the original to the Division of Water Quality,Attn:Information Management,1617 Mail Service Center-
Raleigh,NC 27699-1617, Phone No.[phone],within 30 days.
GW-I REV.09/2004

WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division
of,Water Quality-Groundwater Section
WELL CONTRACTOR(INDIVIDUAL)NAME (print)—OOxku S (.r. CERTIFICATION# � t`�Q
WELL CONTRACTOR COMPANY NAME �V 1u� LZU-k-IrA LLl N PHONE # ISfdk53k�1`9155—
STATE WELL CONSTRUCTION PERMITN ASSOCIATED WQ PERMIT#
(if applicable) / if applicable)
I. WELL USE(Check Applicable Box):Residential R MunicipaUPublic❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCAT ON: opographia/Land setting
Nearest Town, 1�a� County C-��)C-6)2 Ridge ❑Slope []Valley ❑Flat
Vt 1�16 t- -b; . (check appropriate boa)
(Street Nome,Numbers,Cmfnmi4,,Subdivision,Lot No.,Zip Code) Latitude/Iongitude of well location
3. OWNER: `- �� (degreeNmimnes/secouh)
Address )C SCR��T Latitude/longitude source:❑GPS❑Topographic map
� WI( (strut-e�oC a No.) DEPTH (ch«DRILLING LOG
Ciry or Town Shoe Zip Code From To t Fo do D scri tion
�j_ %3r1 — l0 1 _
Ara coda Phone munber
4. DATE DRILLED � 5 OS ISIS
5. TOTAL DEPTH: k
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO J
7. STATIC WATER LEVEL Below Top of Casing:AFT.
(Use-+-if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface' r"r*t
`Top of cuing terminated atior below land surface requires a
varlanee in accordancFArith ISA NCAC 2C.0118.
9. YIELD(gpm): I METHOD OF TEST —
10.WATER ZONES(depth): `J�4Sk to
LOCATION SKETCH
11. DISINFECTION:Type Amount Show direction and distance in miles from at least ,
12. CASING: Wall Thickness two State Roads or County Roads.Include the road';1
Depth Weight/Ft. tonal numbers and common road n es.
From b To Sa, Ft. c-
From To Ft.
From To Ft.
13. GROUT, Depth�-� Meth
From d To Ft.Cnaw
From De Ft. 1 ��JJ
14. SCREEN: Depth Diameter Slot su Material,.-j
From To Ft in. in. _
From To Ft. in. in, j 1,
15. SAND/GRAVEL PAC&Depth w^Ir�
D Size Material �
From To Ft.
From To Ft. _
16. REMARKS: t`ri l04
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WVLL
CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO OWNER
6 2 �9��1e 4 - _ d
S111NATURE OF PERSON CONSTRUCTING THE WELL IDA
Submit the originall 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

3 t y S
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources-Division of Water Quality-Groundwater Section
(INDIVIDUAL)CONTRACrOR(INDDUAL)NAM (print) (2
�) �� �. . CERTIFICATION a�
WELL CONTRACTOR COMPANY NAME Es�tlt\� lU..� WCLA I)ej LAJ4 PHONE 0
STATE WELL CONSTRUCTION PERMIT# ASSOCIATED WQ PERMIT#
(if applicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential 09'/Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION: iTppographiclLand setting
Nearest Town: ftY County Y.OL' MK gee ❑Slope ❑Valley ❑Flat
LAOC ` (check appropriate box)
(Street Name,Numbers,Community,subdivision,Lot No.,Zip code) Latitude/longitude of well location
3. OWNER: L (degreealmimnesleeconds)
Address Latitude/longitude source:❑GPS❑Topographic map
' `,� i(Surat or Route No.) � (check box).
t—'"'tE-� 'L�1L70� DEPTH
�hCity Town state Zip Code From T' Fo do D ri lion
Area Bodo-Phone Dumber bs
4. DATE DRILLED 19b' GIs,
5. TOTAL DEPTH: '
6. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
7. STATIC WATER LEVEL Below Top of Casing:
(Use'+"itAbove Top of Cuing)
8. TOP OF CASING IS , FT.Above Land Surface* ry y
-Top of cuing termlasted at/or below Ind surface requires■ _
variance in accordstep—with 15A NCAC 2C.0118. G
9. YIELD(gpm):�MTV
E ODD OF TEST KTI12 CA
10.WATER ZONES(depth): V
LOCATION SKETCH a
11. DISINFECTION:Type C\-4 Amount Show direction and distance in miles from at least
12. CASING: Wall Thickness two State Roads or County Roads.Include th road
Depth Diameter or Wqq'g,gthtt/Ft. �1at al numbers and common road names.
From To��Ft. - 1�6 J %1. la e
From To Ft
From Tc Ft
13. GROUT: Depth M t4 e(ial Meth
From_To FL
From To Ft.
14. SCREEN: Depth LNameter Slot Stu Material
From To Ft. in. in. ,o
From To Ft. in. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From To Ft.
From To Ft.
16. REMARKS:
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,
CONSTRUCTION ST ARDS,AND THAT A COPYj OF THIS RECORD HAS BEEN PROVIDED TO THEAVELt OWNER
GNATURE OF PERSON CONSTRUCTING THE WELL DATt
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.0712001

RESIDENTIAL WELL CONSTRUCTION RECORD
F' . North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 3368
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Well Contractor(IndMduap Name From 169 To 180' From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6, CASING: Thickness!
MURPHY NC 28906 From 0' Depth
101' R DlamererBO Hlerterlal
City or Town State Zip Code From To R.81�9 I'V(:
8( 28 )_ 837-8008 From To R.
Area code Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0' To 20 R. CEMENT GRAVITY
SITE WELL ID#(if applicable) From To R.
STATE WELL PERMITO(e apppceble) From TO R.
DWQ or OTHER PERMIT If(i applicable) 6. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. _ in.
WELL USE(Check Applicable Box): Residential Water Supply p From To Ft. In. in.DATE DRILLED 10/24/05 From To FL—in. _ in.
TIME COMPLETED AM® PM❑
9. SAND/GRAVEL PACK:
3.WELL LOCATION- Depth Size Material
CITY. MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
SUNNY POINT RD. From To Ft.
(Street Name,Numbers,Community,Subdivision.Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
®Slope OValley ❑Flat DRidge ❑Other From To FDnnabon Description
(check appropriate box) 0' TO 20 RED DIRT
Maybe 1°� '' 20' TO 60. W OROW TAN DIRT
LATITUDE 3 5 02.624N minul®,excidi or
LONGITUDE 8 4 12.783W in a decimal fomut 60' TO 80' BROWN/TAN DIRT 8 BLUE SLATE
80' TO 101' SOFT BLUE SLATE
Latitude/longitude source: t9GPS oTopographic map 10V TO 305' SLATE
(location of we#must be shown on a USGS lopo mop and
attached to this 7orrn snot using GPS) ,
4.WELL OWNER _
OWNER'S NAME RICHARD SHEEKS p 1
STREET ADDRESS PO BOX 1682
BLUE RIDGE GA 30513 —
City IX Town State Zip Code O -
70L 6 )_258-3877
Area code- Phone number
11. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH: 305'
b. DOES WELL REPLACE EXISTING WELL? YES NO13
I W HEREBY CERTIFYTHAT 1MS W ELL WAS CONS RUC1E CE D IN ACCORDAN WITHc. WATER LEVEL Below Top of Casing: 100 FT. 15A NCAC 2c,WELL miSRu STANDARDS,AND THAT A COPY OF THIS
(Use'+'i Above Top of Casing) RECORD INS BEEN PROVIDED TO ME WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface' 1)lij 1' L7 0 uII /1, f h 10/24/05
'Top of casing terminated a0or below land surface may require SIGNATURE OF CERTIFIED CONTRACTOR DATE
a variance in accordance With 15A NCAC 2C.0118.
e. YIELD(gpm): 30' METHOD OF TEST AIR (L 11 Alu �L. 11�\A I I-,
PRINTED NAME OF PERSON.CbNSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Fero cw-m
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7105

a ° RESIDENTIAL WELL CONSTRUCTION RECORD `
J, U S.
TIf North Carolina Department of Environment and Natural Resources Division of Water Quality
WELL CONTRACTOR CERTIFICATION 111 3368
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Well Contractor(Individual)Name From To 180' From To
CHEROKEE WELL DRILLING 8 PUMP CO.INC. From To From To
Well Contract"Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: D Thickness/ ry���
MURPHY NC 28906 From 0' Dept"
MURPHY Ft_ 6 } er V&�1 PVC�I
City or Town State Zip Code From To R.
8( 28 )_ 837-8008 From To Ft.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 01 To 20' Ft CEMENT GRAVITY
SITE WELL IDft(ifapplicable) From To Ft.
STATE WELL PERMITO(a applicable) From To Ft.
DWQ or OTHER PERMIT R(x applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply© From To Ft. in. in.
From To Ft. in. _ in.
DATE DRILLED 10/13/05 From TO Ft. in. _ In.
TIME COMPLETED AM Cl PM❑ 9, SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
PENLAND RD. From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
®Slope ElValkry ❑Flat ®Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 20' RED SLATE
LATITUDE 3 5 01.728N minl®be dorm", 20' TO 100' BROWN/TAN SLATE
_ minu ,seconds
LONGITUDE 83 59.144W m a decimal format 109 TO 133' BLUE SLATE
— — 133' TO 245' SLATE „2
Latitude/longitudesource: MGPS ❑Topographicmap
(bcation of wel must be shown an a USGS topo map and
attached to this form Anot using GPS)
4.WELL OWNER es
OWNER'S NAME DARRYL NEWCOMB O
CA
STREETADDRESS 156 SANDSTONE LANE .-'•
MURPHY NC 28906
City or Town State Zip Code
( 828 1. 360-6036
Area code- Phone number
It. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: 245'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO IN
c. WATER LEVEL Below Top of Casing: 100 I DO HEREBY CERn THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
FT. ISA NCAC2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+•i Above Top or Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 Fr.Above Lard Surface* �Z1.A kj,j _t)c:�;eP Lt,�A 10/14/05
'Top of Casing terminated a0or below land surface may require SIGNATURE OF CERTIFIED. ELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. (]
e. YIELD(rpm): 30 METHOD OF TEST AIR 1 �I 1 A1h "M -1115 -
PRINTED NAME OF PERSON COt STRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, FomnGW-1a
1617 Mall Service Center—Raleigh,NC 2T699-1617 Phone No.[phone] ext 568. Rev.7/05

0-10
RESIDENTIAL WELL CONSTRUCTION RECORD J- v k "`North Carolina Department of Environment and Natural Resources-Division or Water Quality
5y
WELL CONTRACTOR CERTIFICATION N 3401
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 100 PPM
JOHN ARTHUR CHASTAIN g. WATER ZONES(depth):
Well Contractor(Individual)Name From To From To
CHEROKEE WELL DRILLING&PUMP CO.INC. From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 G. CASINO: Thickness/
MURPHY NC 289D6 From 0' DTo 10- Ft Demeter & 11 Material
City or Town State Zip Code From To R.
8( 28 l_ 837-8008 From To R.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From U To 20' Ft CEMENT GRAVITY
SITE WELL ID#(if applicable) From To R.
STATE WELL PERMITHI(if applicable) From_To R.
DWQ or OTHER PERMIT II applicable) B. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Suppty S From To PL_in. _ in.
From To Ft.—in. _ in.
DATE DRILLED 10113/05 From To P.—in. in.
TIME COMPLETED AM O PM O 9, SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MARBLE COUNTY CHEROKEE From To Ft.
From To Ft.
ZEKE'S TRAIL TO GRAY BEARD MTN.TRAIL From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope OValley ❑Flat ®Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 15' RED DIRT
LATITUDE 3 5 09.777N May in��' 15' TO 80' BROWN DIRT
minutes,seconds or
LONGITUDE 83 54.758W in a decimalrormat 80' TO 100' GRAN ITEISET CASING
— — 100' To 905' GRANITE F
Latitude/longitudesoiree: MOPS OTopographicmap
(bcation of we/must be shown on a USGS topo map and
attached to this form�Tnor using GPS) ---i
4.WELL OWNER ;Y OWNER'S NAME ROY ROWLETT Zi
STREET ADDRESS 192 GRAY BEARD MTN.TRAIL _N s
MARBLE NC 28905
City or Town State Z""p Code
( 404 H_218-1943
Area code- Phone number It. REMARKS:
S.WELL DETAILS: BIT SIZE 6.088
a. TOTAL DEPTH:905'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: 900 FT. I NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+'If Above Top or Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface.
, . ,A_�q1 1A�(\ u
'Top of casing terminated War below land surface may require 10/14/05
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): .25 METHOD OF TEST AIR - 1 MM19 tkA-)rnik
PRIN ED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, Form GW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

4nh.r
h
F
RESIDENTIAL WELL coNSTRumoN RECORD a ^'
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#--"i )Lf
1.WELL CONTRACTOR: ,1,, E DISINFECTION:Typer h 0ttr nE Amount
lAj:��l om Cy NL]('1 F I 1 Lipl l ll rl g• WATER ZONES(depth):
Well Contractor(Indradua0 Narq6
PO
-�- From To From To
Q hP rr'llti r k l`Q' G iffi �. YUR1DCu. zt . From To From To
Well Contractor Comptaany�Na� From To From To
STREET ADDRESS � 1 _`�, 6. CASING: IThidmessl
Depth Diameter Weight Material
C D�.1 Ah a n— From To( . R.l I. I st
C or own State Zip Code From_TO R.
_O"CR From_To Ft
Are. Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From To_aCj_R.C'P rX r
SITE WELL ID 9(if applicable) From To R.
STATE WELL PERMIT9(if applicable) From To R.
DWQ or OTHER PERMIT 9(6applicable) B. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From_To R._in. _ in.
1- From To R. in. _ in.
DATE DRILLEDJ1=ll !!) From_To FL—in. _ in.
TIME COMPLETED AM❑ PM❑ S. SANDIORAVEL PACK: -
3.WELL LOCATION: Depth sin Materiel
From To Ft
CITY: COUNTY r 1-DYr�r fh From To Ft.
,]c18%rg Rd From To Ft
(Street Name,Numbers„Community, bdiNsion,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope OValley ❑Flat KIRidge ❑Other From To Formation Descrfption
(check appropriate box) In'
may be in dagn=,
LATITUDE 3 mmutes,scoriam
LONGITUDE_ _ madocimalfamat
,
9
Latitude/longitud[e solace: ❑GPS ❑Topographic map f
(Iccatbn of we9 must be sho m on a USGS topo map and
attached to tKs roan I net using GPS) O a
4.WELL OWNER
-R rs
OWNER'SNAME ' `2
STREET ADDRESS IRd
f-N6AqC, -
9 f"
Cn
Oily a State Zip Code _
Area code- Phone number
11. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOX
^G IDO HEREBY CE"n THATTHISWELLWAS CONSTRUCTEDINACCORDANCEWTH
c. WATER LEVEL Below Top of Casing: JrY. 1 FT. Ise NCAC x,WELL CONSMUCTION STMAtDS,AND THATA COPY of THIS
(Use'+'T Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER
d. TOP OF CASING IS FT.Above Land Surface' ( /
*Top of casing laminated stforwfth below land surface may require SIGNATURE OF CERTIFIED/W L CONTRACTOR OA7E
L-
a variance inaccordance vial i5A NCAC 2C.0116. {'}
e. YIELD(gpm): ��METHODOFTEST �,r T�!,i LLI AFn 4'7Q&0V F� =1n)�i
PRINTED NAME OF PERSON STRUCTiNGTHE WELL
Submit the original to the Division of Water Quality within 30 days. Atbl:Information Mgt, Fero,cW-1a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

I
SIA1�_ D
� n RESIDENTIAL WELL CONSTRUCTION RECORD `x C �-
North Carolina Department of Environment and Nature!Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3368
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 10O PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Well Contractor(Individual)Name From 54U To 560' From To
CHEROKEE WELL DRILLING&PUMP CO. INC. From To From Ta
Well Contractor Company Name From To From To
STREETADDRESS POBOX1007 S. CASING: WThickness!
Depth D ter NMI Malarial
MURPHY NC 28906 From 0' To 100' R. 6 PVI:
City or Tovm State Zip Code From To R.
8! 28 ) 837-8008 From To Ft.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20 Ft. CEMENT GRAVITY
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT9rf applicable) From To R.
DWQ or OTHER PERMIT#(I applicable) 8..SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply[IFrom Tc Ft. in. in.
Fram To R. in. _ in.
DATE DRILLED 10/12105 From To Ft.—in. _ in.
TIME COMPLETED AM❑ PM❑
S. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth size Material
CHEROKEE From To Ft.
CITY: MURPHY COUNTY From To Ft.
TARHEEL From Tc Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
1d�Slope DValley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 20' RED/TAN SLATE
May ben degrca, 20' TO 40' TAWBROWN SUITE
LATITUDE 3 5 05.019N minutes,seconds or
8 4 02.868W in a decimal format 40' TO 60' CLAY/BROWN SLATE
LONGITUDE 60' TO 80' BROWN SLATEIBL ESLATE—
Latitude/longitude source: b(i GPS ❑Topograptuc map 80' TO 100' BLUE SLATE
(bcetnn of war must be shldm on a USGS tope map and 109 TO 605' SLATE
attached to this Ibrm Anof using GPS)
4.WELL OWNER
OWNER'S NAME RICHARD KNEE 71
STREET ADDRESS 57 VALLEY RIVER AVE. Q
--t
MURPHY NC 28906 B•1
City or Town State Zip Code t
L 828 )_837-7817
Area code- Phone number
11. REMARKS: cn
-3
5.WELL DETAILS:
a. TOTAL DEPTH:605'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 13
I DD HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: 75 FT. 15A MAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+•if Above Top of Casing) R
�EC(ORD HAS BEEN PRR/WIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface'" rl�.� �uI).� ID�ta��
'Top of casing terminated atlor below land surface may require SIGNAT11REOF ER-T'IF`I WW'E LCONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. �(}-��rn7��,,,, •• .�..,,11 cc
e. YIELD(grm): t0 METHOD OF TEST AIR WXI-UAAA lJr`rst� rV L1��J
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information,Mgt, Fo mSzw-ta
1617 Mail Service Center-Raleigh,NC 276 9 9-1 617 Phone No.[phone] ext S68. Rev.7I05

4�4 C yn �1i
RESIDENTIAL WELL CONSTRUCTION RECORD 3 ( �' "
North Carolina Department of Environment and Natural Resourccs Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: I. DISINFECTION:Type 100 PPM Amount CHLORINE
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individual)Name From To 65' From To
CHEROKEE WELL DRILLING From To 180' From To
Well Contractor Company Name From To 250' From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
MURPHY NC 28906 From 0' Depth
53' R. Diameter �� Material
City or Twat State Zip Code From To Ft. 81�tl PVI:
8f 28 ) 837-8008 From To Ft.
Area code- Phone number
T. GROUT: Depth Material Method
2.WELL INFORMATION: From 0. To 20 Ft. CEMENT GRAVITY
SITE WELL ID#(if applicable) From To R.
STATE WELL PERMIT#(#applicable) From To R.
DWQ or OTHER PERMIT#(#applicable). 8. SCREEN: Depth Diameter Slot Size Material
From To Ft, in, in.
WELL USE(Check Applicable Box): Residential Water Supply❑
From To Fl._in. _ in.
DATE DRILLED ION8105 From To Ft. in. in.
TIME COMPLETED AM® PM❑
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth size Material
CITY: MURPHY COUNTY CHEROKEE From—To FL
Frorri—To Ft.
JOE BROWN HWY. From To—FL
(Street Nerve,Numbers,Cdnmun#y,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
®Slope UValley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) : 0' TO 1' TOP SOIL
Maybe,t ounds , 1' TO 8' RED SHALE
LATITUDE 3 minutes,seconds or
LONGITUDE in adecunalrormat 8' TO 45' BROWN SHALE
45' TO 60' GRAY SLATE
Latitude/longitude sowee: MOPS oTopographie map 60' TO 305' SLATE
(location of we#must be shown on a USGS topo map and
attached to this form 1 riot usurg GPS)
4.WELL OWNER
OWNER'S NAME L.B.ADAMS
STREET ADDRESS 764 MIDWAY CREEK RD.
MURPHY NC 28906
City or Town State Zip Code
t 828 1.837-2020
Area code- Phone number
11. REMARKS:
S.WELL DETAILS: 6.051 BIT SIZE
a. TOTAL DEPTH: 305'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO fm
I DO HEREBY CERmFYTHAT THISWELL WAS C SfRLICiED IN ACCORDNICEW1IH
c. WATER LEVEL Below Top of Casing: 50 FT. 15A WA .WELL CIXJSmUC11ON STANDARDS,AND THAT A COPY OF THIS
(Use'+'I Above Top of Casing) RECOgD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 Fr.Above Land Surface* / 10119N5
'Top of casing terminated atfor below land surface may require LIGNATURECFCERTIFIEDVVELLCON RACTOR DATE
a variance in acwrdame with 15A NCAC 2C.0118.
e. YIELD(gpm): 3 METHOD OF TEST AIR At�15TOP HER L 11CK
PRINTED NAME OF PERSON-GONST$l!(3 ING THEIWELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form GWAa
1617 Mail Service Center—Raleigh,NC 276994617 Phone No.[phone] ext 560. Rev.7105

5ti11.�
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division ol,Water Quality 3 2 M1 g
- WELL CONTRACTOR CERTIFICATION# 3401
1.WELL CONTRACTOR: F. DISINFECTION:Type CHLORINE Amoud 100 PPM
JOHN ARTHUR CHASTAIN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 208 To 210 From To
CHEROKEE WELL DRILLING From 265 To 267 From To
Weil Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING:
p Thickness/
MURPHY NC 28906 From 0' Depth To 40' FL l of ��dial
City or Town State Zip Code From_To Ft.
(. 828 1- 837-8008 From To Ft _
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
From 0' To 20' Ft, CEMENT GRAVITY
SITE WELL ID A(if apdicaNe) From To Ft.
STATE WELL PERMITC(if applicable) From To R.
DWQ or OTHER PERMIT A(If applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply I?( From_To Ft—in. _ in.
DATE DRILLED 10/17/05 From To Ft._in. _ in.
From To Ft. in. _ in.
TIME COMPLETED 3:30 AM® PM RI
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
HANGING DOG RD. From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
®Slope [;Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 2' TOP SOIL
=�ayLATITUDE 3 5 00.481N2' TO 85' yELLOW SHALE
LONGITUDE 84 60.586W 85' TO 125' RED SHALE
125'TO 300' BLACK SLATE
Latitude/lOngitudesourDB: mGPS ❑Topograplticmap
00cehon of we/must be shown on a USGS fopo map and
affached to this firm 7not using GPS)
4.WELL OWNER
OWNER'S NAME CONNIE CABE
STREETADDRESS 5338 ORCHARD PLACE
MORROW GA 30260
City or Tovm State Zip Code
( 404 1. 366-8914
Area code- Phone number
S.WELL DETAILS: 11. REMARKS:
a. TOTAL DEPTH:
300' 6.050 BIT
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 0
C. WATER LEVEL Below Top of Casing: 100 I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use'+"I Above Top of Casing) RECOOROC S BEEN PnRCVIDED W.WELL D TOOTNHE WELL OWNERD THAT CO'Y OF THIS
d. TOP OF CASING IS 1 FT.Above Land Surface* Q C-�I�t..', ' l -�(1 i7 s ( ;1�j y j
*Top of casing tem ma
dnated at/or below land surface y require 10118/05
a variance in accordance with 15A NCAC 2C.0118. §"NA I V K t OF C1ERTIFIED WE//L��L CONTRAC OR DATE
e. YIELO(gpm): 10 METHOD OF TEST AIR
PRINTED NAME OF PERSON CONSTRUCTING HE,WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
1617 Mall Service Center—Ralelgh,NC 27899-1617 Phone No.(919)73J-7015 ext 568. _Form GW-1'a
1 "� Rev.7/05

5141r. - RESIDENTIAL WELL CONSTRUCTION RECORD W\ V
North Carolina Department of Envimnmenl and Natural Resources Division of Water Quality "f
L ' WELL CONTRACTOR CERTIFICATION N 3401
1.WELL CONTRACTOR: I. DISINFECTION:Type 100 PPM Amount CHLORINE
JOHN ARTHUR CHASTAIN g. WATER ZONES(depth):
Well Connector(IndMdua0 Name From To 140' From To
CHEROKEE WELL DRILLING From To 260' From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: yTyhick1n�1essf
Depth p,�r�e�a, 5��31 PVL:Nl 6ial
MURPHY NC 28906 From 0 To 93- Ft.0 1l8
City or Town State Zip Code From_To Ft.
8f 28 1 837-8008 From To Ft.
Area code- Plane number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0. To 20' R CEMENT GRAVITY
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMITI(I applicable) From To Ft.
DWQ or OTHER PERMIT Il if applcaWe) 8. SCREEN: Depth Diameter Slot Size Material
From To R._in. _ in.
WELL USE(Check Applicable Box): Residential Water Supply❑ From_To Ft. in. in.
DATE DRILLED 10I14I05 From_To Ft. in. _ In.
TIME COMPLETED AM❑ PM❑
S. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CHEROKEE From To Ft.
CITY: ANDREWS COUNTY From To Ft.
PISGAH RD. From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Slope []Valley ❑Flat ®Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 15' RED DIRT
—— May be in degrct_v, 15' TO 30' BROWN DIRT
LATITUDE 3 5 11.003N May
sernndsm
8 3 50 154W in a decimal format 30' TO 80' BROWN DIRTISHALE
LONGITUDE Bo' TO 93' GRANIT SET ASING
Latihtdellongitude source: tsGPS ❑Topographic map 93' TO 405' GRANITE
(location of we/must be shown on a USGS tope map and
attached to this farm If not us6rg GPSJ
4.WELL OWNER
OWNER'S NAME DANNY HARKINS
STREET ADDRESS 61 KIRBY ST.
SUMMERVILLE GA 30747
City or Town Stale Zip Code
( 706 )_822-0139
Area code- Phone number
11. REMARKS:
5.WELL DETAILS: 6.058 BIT SIZE
a. TOTAL DEPTH:405'
la. DOES WELL REPLACE EXISTING WELL? YES❑ NO
1 DO HEREBYCEFMF THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Blow Top of Casing: 100 FT. 15A NCAC W.WELL CONSmLICTION STANDARDS,AND THAT A COPY OF THIS
(Use'+`I Above Tap d Casing) RECORD HAS BEEN PROVIDED TOTHE WELL OWNER.
d. TOP OF CASING IS 1 Ff.Above lard Surface* ` h _.�/-lF4112r, , rba,21n 4 10/19I05
`Top of Casing teminrated atfor below land surface fray require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance With 15A NCAC 2C.0118. _e. YIELD(gpm): 3 METHOD OF TEST AIR •'� ""1 !IkAp G\h 1AiNS
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attu:Information Mgt, Fermi
7617 Mail Service Center—Raleigh,NC 27899-1817 Phone No.[phone] ex(568. J';' U Rev.7I05
_I

I
RESIDENTIAL WELL CONSTRUCTION RECORD
i QA North Carolina Department of Environment and Natural Resources Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 3368
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Well Contractor(Indiuiduall Name From 180' To 200' From To
CHEROKEE WELL DRILLING From 260' To 280' From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/ � r
MURPHY NC 28906 From 0' DTut118' pT_ b)) ater Ws3O I'Vt;®1
City or Town State Zip Code From To Ft.
82( 8 )- 837-BOO8 From To Ft.
Area code- Phone numbw
7. GROUT: Depth Material Method2.WELL INFORMATION: From 0. To 20 Ft. CEMENT GRAVITY
SITE WELL ID s(if applicable) From To Ft.
STATE WELL PERMIT!(0 applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply Ox From To Ft. in. _ in.Fran To Ft. in. in.
DATE DRILLED 11/17/05 From To FL—in. _ M.
TIME COMPLETED AM❑ PM 9, SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
TARHEEL WEST From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
®Slope DValley OFlat ®Ridge ❑Other From To Formation Description
(check appropriate box) o 0' TO 80' REDIBROWN DIRT
May 6emdcgco, 20' TO BO' BROWtJRAN DIRT
LATITUDE 3 _ mmurea,eeamdv a
LONGITUDE in a decimalfamat 80, TO 100, BROWN/TAN DIRTIBLUE SLATE
100'TO 305' BLUE SLATE
Latitude/longitude solace: ❑GPS ❑Topographic map `
(location of wet must be shown on a USGS fopo map and O
attached fo fhs/emr 7rrof using GPS)
4.WELL OWNER
I
OWNER'S NAME GEORGE RIEMENSCHNEIDER
STREET ADDRESS 61618 SADDLE LANE
Ul
ZEPHYR HILLS FL 33543
City or Town State Zip Code _
( 828 t-644-0479
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: 305'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: 100' FT. NCAC 2C,WELL CCNSTRUCTg STANDARDS,AND THATA COPY OF THIS
(Else'+'f Above Top of Casing) RECORD HAS BEEN PROVIDED TOTHE WELL OWNER.
C
d. TOP OF CASING IS I FT.Above Land Surface' 1 / 11I18/05
'Top of casing teminated a8or below land surface may require TORE OF CERTIFIED ELL CONTRACTOR DATE
a variance lo accordance with 1SA NCAC 2C.0118.
e. YIELD(gpm): 10 METHODOFTESTAIR i II I
PRINTED NAME OF PERSON C STRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, pa cw-1a
1617 Mall Service Center—Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.

SIA D V
r � l\E'.SIDE/VTLAL WELL CONSTRUCTION RECORD
North Camhne Department of Environment and Natural Resources Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Indhdduall Name From 17Y To 171' From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1D07 G. CASING: p�� t Thickness/ ��r
MURPHY NC 28906 From 0' Depth
R 6' 1/t3 '" PV(:�I
City or Town State Zip Code From 55 To 59 Pt.-6 1/4 TM— ST EL
6( 28 1- 83743008 From_To R.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 50, Fl CEMENT GRAVITY
SITE WELL ID ftf applicable) From_To R.
STATE WELL PERMITO(if applicable) From_To FI.
DWQ or OTHER PERMIT#(I applicable) a. SCREEN: Depth Diameter Slot size Material
_
WELL USE(Check Applicable Box): Residential Water Supply® From To IL in. in.
From To Ft. in. in.
DATE DRILLED 11/17/05 From_To R—in. in.
TIME COMPLETED 5:30 AM❑ PM p
9. SANO/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From To FL—
From—To—Ft.
CRYSTAL SPRINGS OVERLOOK DR. From To Ft-
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Cade)
��,TrrrOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
Slope OValley ❑Fiat ❑Ridge ❑Other From To Formation Description
(check appropriabs box) U TO 6' RED SHALE
May be in degrees, 6' TO 43' BROWN SANDY SHALE
LATITUDE 3 _ minutes,secwlds or
LONGITUDE__ na decimal fmm.( 43' TO 46' FRACTURED GRANITE
46' TO 605' GRAY GRANITEMHITE QUARTZ
Latitude/longitude source: ❑GPS oTopographic map
(lecatien of wet must be shown on a USGS lope map and
attached to the:form 7nol using GPS)
4.WELL OWNER
OWNER'S NAME SHINER INTERSTATE DEVELOPMENT,INC
STREETADDRESS 513BONITOAVE. _
NOKOMIS FL 34275 n
Cky or Tovm State Zip Code
( 941 I_223-6248 en
Area code- Phone number
il. REMARKS: _C:3 :-
6.WELL DETAILS: -
a. TOTAL DEPTH:605' ;�
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO Eg
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: 0 FT. 15A NCAC IC,WELL CONSTRUC STANDARDS,AND THAT A COPY DIP THIS
(Use-+'N Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
/1
d. TOP p CASING IS 1 FT.Above Land Surface' �L 111,8105
'Top ri casing terminated with below lanCA 2C.01 may require SIGNA OF CE TIFIE WELL— TRACTOR DATE
e variance in accordance W1tlt 15A NCAC 2C.Ot 1 B.
e. YIELD(gpm): 51/2 METHOD OF TEST AIR �►1R..15��• 11
PRINTED NAME OF PERSON CONSTRUCTIN THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information MgL, Forn GW-1a
1617 Mail Service Center—Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7/05
_14 RP rrn gaTR4?

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division or Water Quality
WELL CONTRACTOR CERTIFICATION# 3368
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g• WATER ZONES(depth):
Well Contractor(Individua0 Name From 169 To 180' From To
CHEROKEE WELL DRILLING From 26V To 280' From To
Well Contractor Company Name From To From To
STREETADDRESS POBOX 1007 S. CASING: Thickness)
MURPHY NC 28906 From 0' Depth
71' Ft.by leter Ws&� Material
City or Town State Zip Code From To FL
8( 28 )_ 837-8008 Fran_To R.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0' To 20' R. CEMENT GRAVITY
SITE WELL ID#(if applicable) From_To Ft
STATE WELL PERMIT#(if applicable) From To FL
DWQ or OTHER PERMIT#(N applicable) 8. SCREEN: Depth Diameter Slot Size Material
From To R. in. in.
WELL USE(Check Applicable Box): Residential Water Supply® From To Ft._in. _ in.
DATE DRILLED 11/15105 From To Ft. in. M.
TIME COMPLETED AM❑ PM❑
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY_ MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
PUETT COVE LAUREL DR.LOT#85 From To_Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Cade)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
PSlope []Valley ❑Flat ❑Ridge []Other From To Formation Description
(check appmpdate box) 0' TO 20' REDrrAN SLATE
LATITUDE 3 5 08.088N Maybe socondeo 20' TO 40' TAWBROWN SLATE
minutes,loci exomds a
LONGITUDE 8 3 54.445W m a decimal Cormat 40' TO 71' BLUE SLAT$BLUE SLATE
— 60' To 71' BLUE SLATE
Latitudellongitudesource: InGPS ❑Topographicmap 71' TO 405' SLATE ^1
(location of war must be shown on a USGS topo map and
attached to this form rrrot using GPS) F
4.WELL OWNER G r,
OWNER'S NAME LEE$LINDA BURT N -
STREET ADDRESS 2648 NE 27th AVE. -
FORTLAUDERDALE FL 33306
City or Town State Zip Code f
( 954 )_568-6474 "
Area code- Phone number
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH:405'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 13
I DO HEREBY CERTIFYTw1T THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: 100 FT. 15A NCAC ZC,WELL CONSTRUCTION STANDARDS.AND"TA COPY OF THIS
(Use'+•#Above Top or Casing) RECORD HAS BEEN PROVIDED TOTHE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above land Surface• D'�� n ttJ7r7 11/16/05
*Top of casing terminated atlor below land surface may require SIGNATURE OF CERTIFlE L CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): 10 METHOD OF TEST AIR (-i-)t �u
PRINTED NAME OF PERSON CO_rJSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-le
1617 Mail Service Center—Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Deparbnenl of Environment and Natural Resources-Division of Wafer Quality
WELL CONTRACTOR CERTIFICATION# 3368
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Weld Contractor(IndlMduall Name From 100' To 120' From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
MURPHY NC 28906 From 0' DTot51' R. DlAmeter Malarial
City or Town State Zip Code From To Ft. 81/C PVC:
6( 28 1- 837-8008 From To Ft.
Area cede- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 01 To 20' R. CEMENT GRAVITY
SITE WELL ID/(if applicable) From To R.
STATE WELL PERMITtf(a applicable) From To R.
DWQ or OTHER PERMIT r1(if applicable) B. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply I@ From To R.—in. _ in.
From To R.—in. _ In.
DATE DRILLED IM6/05 From TO R.—in. In.
TIME COMPLETED AM 0 PM❑ 9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
HANGING DOG STORE From To FL
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING 10.DRILLING LOG
❑Slope DValley wFlat ❑Ridge ❑081er From To Formation Description
(check appropriate box) V TO 20' RED SLATE
LATITUDE 3 5 08.305N May be in de®oes' 20' TO 40' RED BROWN DIRT 8 BLUE GRANITE
minutes,sccomh or
imal format 40' TO 165' BLUE GRANITE
LONGITUDE-8 4 02.810W inadec
Latitude/longitudesource: p9GPS ❑Topographicmap
(location of wet must be shown on a USGS topo map and t
atteched to this form 7not using GPS)
4.WELL OWNER
OWNER'S NAME WILLIAM 8 RAY WILSON
STREET ADDRESS 185 DAVIS CREEK RD.
MURPHY NC 28906
City or Town State Zip Code
( 828 1-837-7854
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: 165'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 13
I DOHEREBYCERTIFYTHATIHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
C. WATER LEVEL Beim Top of Casing: FT. 15A NCAC 7C,WELL WNSmUCTON STANDARDS,AND THATA COPY Ct` HM
(Use'+'R Above Top of Casing) RECORD HAS BEEN PROWOED TO THE WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface' / ,. CE LIln� !�.'Ll 11/16/05
//,, �J7, r
'Top of casing tenni ated atfor below land surface may require u-LUfre'/s1
a variance In accordance with 1SA NCAC 2C.0118. SIGNATURE OF CERTIFIED LL CONTRACTOR DATE
e. YIELD(gpm): 20 METHOD OF TEST AIR LL)%UAAti1�kDLEU �9.1t�
PRINTED NAME OF PERSONI N RUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, Form GW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 569. Rev.7MS

r. � RESIDENTIAL WELL CONSTRUCTION RECORD a °I
'S! North Carolina DcpaMlent of Environment and Natural Resources-Division of Water Quality
1 WELL CONTRACTOR CERTIFICATION# 3368
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Well Contractor(Individual)Name From To From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 G. CASING: Thickness/
Depth
MURPHY NC 28906 From 0' To50' Ft.bP � Ls�� F'Vfal
City or Town Stale Zip Code From TO R.
g( 28 1 837-8008 From_To Ft.
Area code- Phone number
T. GROUT: Depth Material Metlgd
2.WELL INFORMATION: From 0. To 20' R CEMENT GRAVITY
SITE WELL ID 0(if applicable) From_TO Ft.
STATE WELL PERMIT!(d applicable) From To R.
DWQ or OTHER PERMIT/(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
-
WELL USE(Check Applicable Box): Residential Water Supply p From To FL—in. in.
From_To FL in. in.
DATE DRILLED 11/14/05 From To IL in. _ in.
TIME COMPLETED AM❑ PM❑
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To FL
TARHEEUFARMER'S TOP DR. From—TO— Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 0' RED SLATE/BLACK SLATE
LATITUDE 3 5 05.561N May be in dedeg.,, 5
20' TO 0' BLUE SLATE
rmrmlm, d.loan a
LONGITUDE_84 03.777W madaonal format 50' TO 705' SLATE
Latitude/longitude solace: EIGPS ❑Topographic trap
(location of weI must be shown on a USGS tape map and
attached to this form snot using GPS)
4.WELL OWNER
OWNER'S NAME FORREST WHEELER -
STREETADDRESS 980HWY.64WEST
Cp
MURPHY NC 28906
City or Town State Zip Code Ili
828 1.837-9989
Area code- Phone number
11. REMARKS: On
6.WELL DETAILS:
a. TOTAL DEPTH: 705'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO Eq
I DO HEREDY CERTFYTHATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE W RH
c. WATER LEVEL Below Top of Casing: 50 FT. 115A NCAC M.WELL CONSRtUCTIDN STANDARDS,AND THAT A COP'CF THIS
(Use'+•if Above Top of Casing) RECOttD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 Fr.Above Land Surface' �-i1 J1QnU�fl f1�1 ,v� 11/15/05
'Top of easing tominated allor below land surface Trey require SIGNATURE OF CERTIFIED CL G.ONTRACTOR DATE
a variance in accordance With 15A NCAC 2C.0118. 1 .
e. YIELD(gpm): 2 METHOD OF TEST AIR I C�\ ti111 0 (LLb\_tAA V-171i1�
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-ta
1617 Mail Service Center—Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7105

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Rcsources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 2261
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individual)Name From To From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 S. CASINO: Thicknessf
MURPHY NC 28906 From 0' DTo 185' R Dmmeter Igo M to eial
City or Tovvn State Zip Code From 185' To 196' Ft. 6114 -i8i£— SSTVEEL
8( 28 1.837-8008 From To Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
From U' To 20' Ft. CEMENT GRAVITY
SITE WELL ID R(if applicable) From To Ft.
STATE WELL PERMIT#(a applicable) From TO R.
DWQ or OTHER PERMIT*(II applicable) 8. SCREEN: Depth Diameter Slot Size Material
_
WELL USE(Check Applicable Box): Residential To FL—in. in.
al Water Supply p From To R, in. in.
DATE DRILLED 11/11/05 From To FL—in. in.
TIME COMPLETED 4:00 AM❑ PM
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft--
From—To—FL
BLAIRSVILLE HIGHWAY From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley NFlat ❑Ridge ❑other From To Formation Description
(check appropriate box) 0' TO 8' RED SHALE
MayLATITUDE 3 5 01.178N min tromde d. 8' TO 63' BROWN SHALE
minutes,raronda a
LONGITUDE 8 4 05.532W in a decimal format 63' TO 73' GRAY SHALE
—— 73' TO 150' BROWN SHALE
LatitudeAongitude solace: (nGPS OTopographic map 150' TO 400' GRAY SLATE
(bcation of wet most be shmvn on a USGS tope map and
attached to Ibis form Inot using CPS)
4.WELL OWNER ,
OWNER'S NAME CHRISTINAGUTHRIE Ntl
STREETADDRESS 1086BLAIRSVILEHWY
MURPHY NC 28906
City or Tmun State Zip Code
( 828 )_837-5836
Area code- Phone number
11. REMARKS:
S.WELL DETAILS: 6.015 BIT SIZE
a. TOTAL DEPTH:400'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO CM
I W HEREBYCERTIFYTFIAT THIS WELL WAS CONSTRICTED IN ACCORDANCE W oN
c. WATER LEVEL Below Top of Casing: 60 FT. 15A NCAC K,WELL CDNSTRUGTIDN STANDARDS,AND TTIATA COY OF THIS
(Use'+'T Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL MNER.
d. TOP OF CASINO IS 1 FT.Above Land Surface* Ol lsnr2/IA V� I-S- / k ju 11/15/05
'Top of casing terminated allm below land surface may require SIGNATURE OFCERTIFIED WELL CONT TOR DATE
a variance k1 accordance with 15A NCAC 2C.0118. n 1
e. YIELD(gpm): 10 METHOD OF TEST AIR \,H�t• 1t\p ��� `�- �vC
PRINTED NAME OF PERSON CONSTRUCTfNG THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, Form GW-1■
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7105.

3
S RESIDENTIAL WELL CONSTRUCTION RECORD ) -1 �, a
North Carolina Department pertrnent o(l:nvironment and Natural llesouTces-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3368
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
War Contractor(IndMdwo Name From 180' To 200' From To
CHEROKEE WELL DRILLING From 269 To 280' From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING:
Thickness!
MURPHY NC 28905 From 0' De 15T Fl bP ter Ws��e �ral
City M Town State Zip Code From To R. _
8( 28 )_ 837-8008 From TO Ft. _
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL ID#ita From 0. To 20' Ft. CEMENT GRAVITY
( PdicaDle) From To FL
STATE WELL PERMIT#(#applicable) From Tc Ft.
DWQ Of OTHER PERMIT#(#applicable) 9. SCREEN: Depth Demeter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply I0 From To_R_in. _ In.
_
DATE DRILLED 11/10/05 From To Ft._in. in.
From To F[._in. in
TIME COMPLETED AM PM
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To_Ft.
WARREN DRIVE From To_Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
Pope OValley ❑Fiat ❑Ridge ❑Other From To Forrnabon Description
(check appropriate box) 0' TO 140' RED DIRT TALC
May be in dcgroa,
LATITUDE 3 5 01.179N 149 TO 15T TALC
mmutea,records or
LONGITUDE 84 05.531 W in a decimal format 157' TO 305' —T PLR
LaGtude/lungitude SOtlrce: InGPS ❑Topographic map
(locahun of war must be shown on a USGS top,map and
attached to(his 6Tnn#not using GPS)
4.WELL OWNER
OWNER'S NAME CHARLES MILLER
STREET ADDRESS 721 TARHEEL WEST _
MURPHY NC Y8906
City or Town State Zip Code �
82( 8 )_837-6438
Area code- Phone number
S.WELL DETAILS 11. REMARKS: .
a. TOTAL DEPTH: 305'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
C. WATER LEVEL Below To of Casing: IDO HEREBYCERVF THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
P 9 CO FT. 115A NCAC]C,WELL CONSTRUCDON STANDARDS,AND THATA COPY OF THrS
(Use'+•#Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface-
-Top
(�
-Top of casing tenrimated atlor be bw land surface may require ",-�=-,,. — U»�fi��^^i-h(`� t< n 11/15/05
a variance in accordance With 15A NCAC 2C.0118. SIGNATURE OF CERTIFIED WJr L CONTRACTOR DATE
e. YIELD(gpm): 10 METHOD OF TEST AIR Ii )I111 p&6PAN,n
PRINTED NAME OF PERSON C NSTRUCTING THE WELL
Submit the original to the Division of Water Quality Within 30 days. Attn:Information Mgt,
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Form GW-1a
Rev.7/05
f

� f f
3 ' RESIDENTIAL WELL CONSTRUCTION RECORD
Notlh Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
3368
1.WELL CONTRACTOR: L DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Well Contractor(Individual)Name From 129 To 149 From To
CHEROKEE WELL DRILLING From 140' To 160' From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 S. CASING: Thickness/
Depth D ler 5SO21 Materal
MURPHY NC 289M From 0' To 98' R.6 W PVT;
City or Town State Zip Code From To Ft.
8( 28 )_ 837-8008 From_To Ft.
Area code- Phone number
7. GROUr: Depth Material Method2.WELL INFORMATION: From 0 To 20' Ft CEMENT GRAVITY
SITE WELL ID lf(if applicable) From To Ft.
STATE WELL PERMITRI(I applicable) From To FL
DWQ or OTHER PERMIT I(If applicable) 9. SCREEN: Depth Diameter Slot Size Material
From To Ft—in. _ in.
WELL USE(Check Applicable Box): Residential Water Supply[0 FromTo FL—in. _ in.
DATE DRILLED 11/03/05 From To Ft. in. in.
TIME COMPLETED AM❑ PM❑
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Sae Material
CITY. MURPHY COUNTY CHEROKEE From To FL
From To FL
HORTON RD. From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel.Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope OValley ❑Fat RRidge ❑Other From To Formabon Description
(check appropriate box) 0' TO 20' SAND
May be m degrees' 20' TO 40' SANDIHARD BLACK GRANITE
LATITUDE 3 _ minutes,seconds or
LONGITUDE inadecimalformat 40' TO 98' BLUEGRANITE
—— 98' TO 205' GRANITE
Latitudc/longitode source: OGPS OTopographic map
(location of war must be drown on a USGS tope map and i
attached to this roan 7not using GPSI ..
4.WELL OWNER
CD
OWNER'S NAME STEVE CRAWFORD C
STREET ADDRESS PO BOX 29801
MURPHY NC 28906 1
City or Town State Zip Code Ln
( 828 )_421-2915 -3
Area code- Phone number
11. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH: 206
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO(3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONStRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: so FT. 1ST NCAClC,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+•I Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface h/Vow - �f j��A 11/07/05
'Top or casing terminated at/or below lard surface may require SIGNATURE OF C RTIFIED ELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. 0. `,
e. YIELD(gpm): 7 METHOD OF TEST AIR VJIWAA ,J���-V L��
PRINTED NAME OF PERSON C NSTRUCTIN THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:lnfomla8on Mgt, Form GW-ia
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

519rI ,�
E f RESIDENTIAL WELL CONSTRUCTION RECORD 1 T �E��C"
J I �
l� North Carolina Department of Environment and Natural Resources-Division of Water Quality
0_.. WELL CONTRACTOR CERTIFICATION N 3368
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Well Contractor(IndiAdua9 Name From 160' To 180' From To
CHEROKEE WELL DRILLING From TO From To
Well Contractor Company Name From To From To
STREETADDRESS POBOX1007 G. CASING: D Thickness/ �alar
MURPHY NC 28906 From 0' Depth
R. 6 alter IN PV(;�I
City or Town State Zip Code From To Ft.
8( 28 )- 837-8008 From To Ft.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 01 To 20 Ft. CEMENT GRAVITY
SITE WELL ID R(if applicable) From To Ft.
STATE WELL PERMIT,t(if applicable) From To Ft.
DWQ or OTHER PERMIT E(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply© From To Ft. in. in.From To P._in. in.
DATE DRILLED 11/02/05 From To Ft. in. in.
TIME COMPLETED AM❑ PM❑ 9. SANDIGRAVELPACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From Tc Ft.
From To Ft.
BOULDER CREEK(RED OAK FOREST) From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Cade)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
®Slope OValley ❑Flat DRidge ❑Other From To Formation Description
(checkapprophatebox) 0' TO 20' RED SLATE
LATITUDE 3 May be in deem' 20' TO 109 BROWN SLATE
mint®,seconds or
LONGITUDE in.decimal format 100' TO 129 BROWN SLATE TO BLUE SLATE
— — 120' TO 225' DARK BLUE SLATE
LatitudeAcrigitude source: ❑GPS OTopograpMe map
(location of wet must be shown on a USGS topo map and
aHached to this form tnot using GPS) 1
' e
4.WELL OWNER
OWNER'S NAME DELBERT A.HENDERSON JR. o -
STREET ADDRESS PO BOX 288
CRYSTAL SPRINGS FIL 33524 r
City or Town State Zip Code O
( 813 )_404-4269
Area code- Phone number
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH:225'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 0
DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
C. WATER LEVEL Below Top of Casing: 60 FT. I'M NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+'if Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 Fr.Above Land Surface' /,[�/� �� �7�j -1r'�A.� 11/07/05
'Top of casing terminated atior below land surface may require SIGNATURE OF CERT IE WELL ONC TRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. (E�R r, 1 1 ^
e. YIELD(gpm): 10 METHOD OF TEST AIR �(LLIAM &At1LEq �.E1�1)-LIAM &AUEq L.tD115
PRINTED NAME OF PERSON C NSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, FormcW-1a
1617 Mail Service Center-Raleigh,NC 27899-1617 Phone No.[phone] ext 568. Rev.7/05

RESIDENTIAL WELL CONSTRUCTION RECORD L �-
J TTI`' North Carolina Department of Environment and Natural Resources-Division of Water Quality
( WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amcrmt 10O PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individual)Name From 179 To 171' From To
CHEROKEE WELL DRILLING From To From To
W ell Connector Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
Willi
MURPHY NC 28906 From 0' Dept
92' Ft. pNoter VSORPi
City or Town State Zip Code From To Fl.
8( 28 1 837_8008 From_To Ft.
Area code Phone number
T. GROUT: Depth Material Method
2.WELL INFORMATION: From 0. To 20' Fl CEMENT GRAVITY
SITE WELL ID Jilif applicable) From To R
STATE WELL PERMIT#(#applicable) From To R.
DWQ or OTHER PERMIT n1(ff applicable) B. SCREEN: Depth Diameter Slat Size Material
From To R._in. _ in.
WELL USE(Check Applicable Box): Residential Water Supply® From To Rill. in.
DATE DRILLED 11/03105 From_To R. in. _ in.
TIME COMPLETED 10:00 AM(A PM
9. SANDlGRAVEL PACK:
3.WELL LOCATION: Depth Sae Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
1734 DOVE HOLLOW RD. From To R.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
L'Slope G'Valleyi Flat ❑Ridge [)Other From To Formation Description
(check aW. priate box) 0' TO 2' TOP SOIL
May be in degrm, 4' TO 8' RED SHALE
LATITUDE 3 _ minor=,eecondam
LONGITUDE in adocimalfomut 8' TO 75' BROWN SANDSTONE
— — 75' TO 82' BROWN GRANITENVHITE QUARTZ
Latitude/longitude source: ❑GPS ❑Topographic map 82' TO 130' GRAY GRANITE
(location of we#must be shown on a USGS topo map and 130' TO 134' WHITE QUARTZ
attached to this form 7notusirg GPS) 134' TO 180' GRAY GRANITE/WHITE QUARTZ
4.WELL OWNERy
OWNER'S NAME MERO BERNARD
STREET ADDRESS 1734 DOVE HOLLOW RD. CT
MURPHY NC 28906
City or Town State Zip Code ON
( 828 1.644-5725 k:E)
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: 180' '
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I DO HEREBY CERn"THAT THIS WELL WAS CONSMUC1ED IN ACCORDANCE W M4
c. WATER LEVEL Below Top of Casing: 45 FT. 1SA NCAC IC,WELL CONSTRUCTION STANDARDS,AND TNT A COPY GF T 15
(Use'+'b Above Top of Casing) RECORD HAS BEEN PROVIDED TITHE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface' / 11104/05
'Top ofcasing terminated at/or b land surface may require ��t'8`��
a variance in accordance With i5A NCAC 2C.0118. (SIIGNAT RE OF CER I1FIED ELL CONTRACTOR DATE
e. YIELD(gpm): 30 METHOD OF TEST AIR \�k�0.15�P tiu L. OIC-��
PRINTED NAME OF PERSON CONSTRU TING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Foam GW-ta
1617 Mail Service Center-Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7/05

I
SIAn
RESIDENTIAL WELL CONSTRUCTION RECORD 1 ` �
North Carolina Department of Environment and Natural Kesomces Division of Water Quality
. w_o
WELL CONTRACTOR CERTIFICATION N 2261
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individuall Name From 260' To 261' From To
CHEROKEE WELL DRILLING From 450' To 451' From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
MURPHY NC 28906 From 0' DTo 80pth ' R B1�tl PVC Dimeter %inMaterial
City or Town State Zip Code
Code From To F
828 1- 837-8008 From_To FL
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0. To 20' Ft CEMENT GRAVITY
SITE WELL ID f(if applicable) From To R.
STATE WELL PERMITf(1l applicable) From To FL
DWQ or OTHER PERMIT#(it applicable) B. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply© FromTo P.—in. — in.
From_To R.—in. in.
DATE DRILLED 11/04105 From To I'L in. _ in.
TIME COMPLETED 3:30 AM❑ PM❑
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
CLIFF RAPER RD. From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: - 10.DRILLING LOG
FgSlope oValley ❑Flat ❑Ridge []Other From To Formation Description
(check appropriate box) 0' TO 12' RED SHALE
May— minus be in dcgr ounds a' 12' TO 40' BROWN SANDSTONE
LATITUDE 3 nutes mi
LONGITUDE in a dec,imal fomut 40' TO 72' GRAY GRANITE
72' TO 180' GRAY GRANITE/WHITE QUARTZ
Latitude/longitude source: ❑OPS ❑Topographic map 180'TO 195' WHITE QUARTZ
(location of we/must be shown on a USGS tope map and 195'TO 500' WHITE QUARTZ/GRAY GRANIF'E
attached to this form Knot using GPS) ,.
4.WELL OWNER
OWNER'S NAME RONALD CARPENTER
STREET ADDRESS 1105 CLIFF RAPER RD.
MURPHY NC 28906 .,e.
City a Town State ZipCode PR '
( 828 1- 644-0620
Area code- Phone number
11. REMARKS:
5.WELL DETAILS: 6.106 BIT SIZE
a. TOTAL DEPTH: 505'
b. DOES WELL REPLACE EXISTING WELL? YES D NO 0
I DO HEREBY CEIMIfYTHAT THIS WELL WAS CONml1 SCTED IN ACCORDANCE W rIM
c. WATER LEVEL Below Top of Casing: 60 FT. 15A NCAC 2C,WELL CONSrRUC11ON STANDARDS,AND THATA CCPY OF THIS
(Use•+'it Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 Fr.Above Land Surface' �/ �� �1 �p �L 11107/05
'Top of casing terminated aVerWith below lend surface may require Sl t '� F D W
a variance in accordance with 15A NCAC 2C.0118. GNATU F CERTI IE E'L�L C TRACTOR DATE
e. YIELD(gpm): 1/3 METHOD OF TEST AIR (-'MA D AM L-
PRINTED NAME OF PERSON CONSTRUCTINP THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, FormGW-la
1617 Mail Service Center—Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7105

' RESIDENTIAL WELL CONSTRUCTION RECORD
J T
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 3368
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Well Contractor(IndMdmq Name From 80' To 100' From To
CHEROKEE WELL DRILLING From To From To
Well Connector Company Name From To From To
STREET ADDRESS PO BOX 1007 S. CASING: Thickness/
Depth p ter KI Mat€vial
MURPHY NC 2B906 From 0' To 50' Ft.—
6�l� W PVI:
City or Town State Zip Code From To R.
8( 28 )_ 837-8008 From To Ft.
-
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
From 01 To 20' R. CEMENT GRAVITY
SITE WELL ID 3(it applicable) From To Ft.
STATE WELL PERMITCff applicable) From To R.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
WELL USE(Check Applicable Box): Residential Water Supply p
From To Ft. in. in.
DATE DRILLED 10/27/05 From To Ft. in, in.
TIME COMPLETED AM D PM❑
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
175 ATOAH LOOP INDIAN ROCK SPRINGS From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,parcel,Zip Cade)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope DValley ❑Flat ❑Ridge ❑other From To Formation Description
(check appropriate box) , 0' TO 40' BROWN DIRT/GRAVEL BED
May t e m degroconds o 20' TO 40' BOULDER/SAND/GRAVFI/GRANITE
LATITUDE 3 minutes,seconds m
LONGITUDE in a dwimal format 40' TO 50' BLUE GRANITE
50' TO 225' GRANITE
Latitude/longitude solace: ❑GPS DTopograpluc map `
(location of wet most be shown on a USGS topo map and s
attached to this loon If not using GPS) -
I
4.WELL OWNER
OWNER'S NAME BILL HAYES C r.
STREET ADDRESS 1916 PIER DRIVE iP
RUSKIN FL 33570 _
City a Town State Zip Code
( 813 1.645-5948
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: 226
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO t3
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRl1CTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: 50 Fr. 15A NCAC2 ,WELL CONSmVCIION STANDARDS,AND THAT A COPY OF THIS
(Use'+'I Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 Fr.Above Land Surface' 1 10/28/05
'Top of casing terminated allor below land surface may require 1 L�f -, �x7 C[4 TgIT�l4—
a variance in accordance With 15A NCAC 2C.0118. ,S•I(G�\NATU RE OF CERTIFIED ECL C 111ON1��T�R11ACCTOR DATE
e. YIELD(gpm): 20 METHOD OF TEST AIR Q(w �9�U ``I C
PRINTED NAME OF PERSON CO STRUCTINNG Ik E WELL
Submit the original to the Division of Water Quality within 30 days. Attn:InformaUon Mgt, Fom,GW-ta
1617 Mall Service Center—Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7105

I
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 10O PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individual)Name From 170' To 175' From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREETADDRESS PO BOX 1007 6. CASING: Thickness/
MURPHY NC 28906 From 0' DTot 116' Ft Diameter Wsb� � �a�ral
City or Town State Zip Code From To Fl.
8( 28 1 837-8008 From To R.-
Am code- Phone number
T. GROUT: Depth Material Method
2.WELL INFORMATION: From 01 To 20' R. CEMENT GRAVITY
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(#applicable) From To Ft.
DWQ or OTHER PERMIT#(#applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply f7 From To Ft. in. in.
From To Ft. in. _ in.
DATE DRILLED 11/01/05 From To FL in. in.
TIME COMPLETED 1:30 AM D PM
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Sin Material
MURPHY CHEROKEE From To Ft.
CITY: COUNTY From To Ft.
LOWER BEAR PAW RD. From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No..Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
ISSlope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 2' TOPSOIL
LATITUDE 3 5 07.048N May be in degrees' 2' TO 10, RED SHALE
minutes,seconds or
LONGITUDE 84 11.478W in a decimallormat 10' TO 65, BROWN SANDY SHALE
65' TO 82' GRAY SLATE
Latitude/longitude source: EGPS ❑Topographicmap 82' TO 84' BROWN CLAY
(location of we#must be shown on a USGS tope map and 84' TO 205' GRAY GRANITE _
arached to this farm#not using GPS)
4.WELL OWNER
OWNER'S NAME PAULA DOSS
STREET ADDRESS 3910 LA PALMA ST. t
FT.MYERS FL 33901
City a Town State Zip Code
239 )_277-0314 Area code- Phone number `--g
11. REMARKS: -°
5.WELL DETAILS:
a. TOTAL DEPTH: 205'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO IN
DOHEREBYCERTIFYTINTTHISWELL WAS CCNS UCIED IN ACCORDANCEWRH
c. WATER LEVEL Below Top of Casing: 50 FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT COPY OF THIS
(Use'+•#Above Top of Casing) RECORD HAS BEEN PRUJIDED TOTHE WELL OWNER,
d. TOP OF CASING IS 1 FF.Above(and Surface* 10 11/02/05
'Top of casing t rininated atfor below land surface may require G REeF CERTIFIED L C T
a variance in accordance Kith 15A NCAC 2C.0118. SYGGNATURNOF CERTIFIED WELL DATE
e. YIELD(gpm): 50 METHODOF TEST AIR OAVJJ ,IDPNER L. NC KF-3
PRINTED NAME OF PERSON CONSTRU TING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, Form Gw-ta
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. - Rev.7105

I
RESIDENTIAL WELL CONSTRUCTION RECORD OP i
North Camhna Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3368
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Well Contractor(Individuap Name Fran TO From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
Depth D / PV(:ter VS(Igo1j Mat i.1
MURPHY NC 28906 From 0' To 90 Ft. b
City or Town State Zip Code From To Ft.
8( 28 1. 837-8008 From To FL
Area code- Phone number
7. GROAT: Depth Material Method
2.WELL INFORMATION: From 0' To 20' R. CEMENT GRAVITY
SITE WELL ID A(if applicable) From To Ft.
STATE WELL PERMITA(i applicable) From To Ft.
DWQ or OTHER PERMIT A(d applicable) 8. SCREEN: Depth Demeter Slot Size Material
From To Ft. in. _ In.
WELL USE(Check Applicable Box): Residential Water Supply O From To Ft. in. In.
DATE DRILLED 11/01105 From To Ft. in. in.
TIME COMPLETED AM❑ PM❑
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
INDIAN ROCK SPRINGS(SAKANAGA DR.) From To Ft.
(Street Name,Numbers,Communty,Subdivision,Lot No.,Parcel,Zip Cade)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
CgSlope [3Valley ❑Flat []Ridge ❑Other From To Formation Description
(check appmpdale box) 0' TO 20' RED BROWN SLATE
A1ay e�'"� '' 20' TO 60' BRl7WNlTAN SLATE
LATITUDE 3 6 02.733N 13.70 minulo,malseconds m
LONGITUDE 84 nW madwifrmal 60' TO 80' BROWNITAN TO BLUE SLATE
eo' TO 805' BLUE SLATE
Latitudeflongitudesource: MGPS ❑Topographiclnap _
(bcation of wet must be shown on a USGS topo map and
anached to this Iran IF not using GPSI
4.WELL OWNER G
OWNER'S NAME KEVIN FLINN l
STREET ADDRESS PO BOX 33256
PALM BEACH GARDENS FL 33428 U-1
City or Town State Zip Code
L561 (-798-4763
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: 805'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 12
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH '
C. WATER LEVEL Below Top of Casing: FT. MNCAC W,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+'A Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 Fr.Above Land Surface* '�-Af7�n L.l� y 1�'Q l 11102/05
'Top of casing terminated atlor below land surface may require SIGNATURE OF CERTIFIE C7�/��1L�ELL CONTRACTOR DATE
a variance in accordance With 15A NCAC 2C.0118. 1' (]��� I
e. YIELD(gpm): 1/5 METHOD OF TEST AIR W1111AM 1._4{Ht)LE� 1�11�15
PRINTED NAME OF PER .'CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, Form Gw-la
1617 Mail Service Center—Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7M5
W,"v:

..:5lpit.," V
3' �Y� 5. RESIDENTIAL WELL CONSTRUCTION RECORD
y'/ �4` North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(IndMduap Name From To From Ta
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 G. CASING: WThickness/
Depth p ter 521 Material
MURPHY NC 28906 From 0' To 80' Ft. 6 W PVC:
City or Town State Zip Code From_To Ft.
8( 28 )- 837-8008 From To Ft.
Area code- Phone number
T. GROUT: Depth Material Method
2.WELL INFORMATION: From 01 To 20' Ft CEMENT GRAVITY
SITE WELL ID#(if applicable) From To Ft
STATE WELL PERMITf lapplicable) From To R.
DWQ or OTHER PERMIT 1(d applicable) 8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
WELL USE(Check Applicable Box): Residential Water Supply[]
From To Ft.—In. in.
DATE DRILLED 10/26t05 From To Ft. in. in.
TIME COMPLETED 4:00 AM❑ PM p
8. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
qTy; MURPHY COUNTY
CHEROKEE From To Ft.
From To Ft.
EAGLE POINT DEVELOPMENT WELL#1 From To R.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope oValley pq Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 8' RED SHALE
May be in degrees, 8' TO 71' BROWN SANDY SHALE
LATITUDE 3 _ minutes,emends or
LONGITUDE in a decimal format 71' TO 107' BLACK GRANITEIWHITE QUARTZ
— — 107' TO 111' WHITE Q ARTZ
Latitude/longitude source: ❑GPS ❑Topographic map 111' TO 115' RED QUARTZ
(location of wet must be shown on a USGS topo map and 115' TO 140' GRAY SHISTAMHITE QUARTZ
attached to this Porm Arwtusing GPS) 140' TO 300' GRAY SHIST/RED QUARTZ
4.WELL OWNER 3W TO 375' GRAY SHIST
OWNER'S NAME PHYLLIS HOUSE(EAGLE POINT DEVELOPMENT) 375' TO 705' GRAY SHIST/RED 8 WHITE QUARTZ
STREET ADDRESS 1237 LADY MARION LANE
DUNEDIN FL 34698 I
City or Town State Zip Code eD �
( 813 (-601-7203 - '
Area code- Phone number
11. REMARKS:
S.WELL DETAILS: -7
a. TOTAL DEPTH: 705'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO III
I DO HEREBY CERnFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
C. WATER LEVEL Below Top of Casing: 0 FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+•d Above Top of Casing) RECORD HAS BEEN PROVIDED TOTHE WELL OWNER.
d. TOP OF CASING IS 1 Fr.Above Land Surface' // . ' - �� 10/27/05
'Top of casing temdnated atior below land surface may require
a variance,in accordance With 15A NCAC 2C.0118. SIGNATUR OF CERTIFIED W ELL CO TRACTOR DATE
e. YIELD(gpm): 0' METHOD OF TEST AIR 'C)104E�
PRINTED NAME OF PERSON CONS UCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., FonmGW-la
1617 Mall Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7105
I . r-

SIA2. V
RESIDENTIAL WELL CONSTRUCTION RECORD A, 1� A
North Carolina Department of Environment and Natural Resources Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individual)Name From To From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
MURPHY NC 28906 From 0' DTo 8Y Ft bp,~a/r�reter �s&14$1 Malarrial
City or Town State Zip Code From To Ft. PVI:
8( 28 )_ 837-8008 From To FT.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20' FL CEMENT GRAVITY
SITE WELL ID#(if applicable) From To Ft
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(N applicable) B. SCREEN: Depth Diameter Slot Size Material
From To R. in. in.
WELL USE(Check Applicable Box): Residential Water Supply© From To Ft. in, in.
DATE DRILLED 10/28/05 From To Ft. in. In.
TIME COMPLETED 4:30 AM❑ PM
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Sze Material
MURPHY CHEROKEE From To Ft.
CITY: COUNTY From To—Ft.
EAGLE POINT DEVELOPMENT WELL#2 From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley W1FIat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 12' RED SHALE
May be in deg,=, 12' TO 65' BROWN SANDY SHALE
LATITUDE 3 _ minutes,aemnda or
LONGITUDE in a decimal format 65' TO 375' GRAY GRANITE/1NHITE QUARTZ
—— 375' TO 70T GRAY GRANITE/RED d WHITE QUARTZ
LatitudcAongitude source: ❑GPS ❑Topographic map
(bcathn of we/must be shown on a USGS tope map and _
attached to this form#nol using GPS)
4.WELL OWNER
OWNER'S NAME PHYLLIS HOUSE(EAGLE POINT DEVELOPMENT) C3 '
STREET ADDRESS 1237 LADY MARION LANE I
n
DUNEDIN FL 34698
City or Town State Zip Code O ��
( 813 )_601-7203 _
Area code- Phone number
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH: 705'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 13
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSMUCTED IN ACCORDANCE WrTH
c. WATER LEVEL Below Top of Casing: 0 FT. IM NCAC]C,WELL CONSfRUCTICN STANDARDS,AND THAT A COPY OF THIS
(Use'♦'I(Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER,
d. TOP OF CASING IS 1 FT.Above Land Surface' IGNATU( 17d1 ,^ 11/02t05
ma'Top of casing terminated atior below land surface y require S E OF CERTIFIEDWELL ONTRACTOR DATE
a variance inaccordance with 15A NCAC 2C.0118. l r�
e. YIELD(gpm): 0' METHOD OF TEST AIR CNRISC�P�1F Q L. �J\CEO
PRINTED NAM OF PERSON CONSTRUCTI G THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, Form GW-1s
1617 Mail Service Center—Raleigh,NC 276994617 Phone No.[phone] ezt 568. Rev.7/05

I
slat
x }��5rrC Mks RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources Division of Water Quality
2..i
WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 10O PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individual)Name From 170 To 172 From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
MURPHY NC 28906 From Or Depth
32' Ft ag'eter WS�0�j MaMral
City or Town State Zip Code From To Ft. age
FVC
(.828 837_8008 From To Ft.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 01 TO 20' Ft CEMENT GRAVITY
SITE WELL ID A(if applicable) From To Ft.
STATE WELL PERMITA(d applicable) From To Ft.
DWQ or OTHER PERMIT#(I applicable) 8. SCREEN: Depth Diameter Slot Sae Material
From To Ft. in. in.
WELL USE(Check Applicable Box): Residential Water Supply p
From To Ft. in. in.
DATE DRILLED 11/02/05 From To Ft. in. in.
TIME COMPLETED 11:30 AM® PM
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Sae Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
CANDY MTN.RD.(BEHIND JODY DOCKERY) From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat KRidge 00ther From To Formation Description
(check appropriate box) May
0' TO 0 BLACK SLATE
May be in dcgrm, 8' TO 10' BROWN GRANITE
LATITUDE 3 minutes,second,or BLACK GRANITE 8 WHITE QUARTZ
LONGITUDE in a decimal format 10' TO 200'
Latitude/longitudesource: ❑GPS ❑Topograptuctrap
(lecatkin of weir must be shown on a USGS tope map and
attached to Iha corm Anot using GPS)
4.WELL OWNER
tiI
OWNER'S NAME ROGER COPENHAVER
STREET ADDRESS 30 BEE TREE LANECHI
MURPHY NC 28906
City or Town State Zip Code -'
( 828 1.837-3848
Area code_ Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: 200'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I WHEREBY CERTIFY TTNISWELL WAS CCNSRUC1EDINACCORDANCEWmt
a WATER LEVEL Below Top of Casing: 50 Fr. T15A NCAC 2C,WELL CCNSmUC STANDARDS,ANDTHATA C OFmrls
(Use'+•A Above Top of Casing) RECORD HAS BEEN PROVIDED TOTHE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface' t I t(Jl` r�1)��; ) J.L{''�2/ 11/03/05
*Top dpsing terminated atlor be low land surface may require §IGNATUR E4CERTIF11h WELL CO NT CTOR DATE
a variance In accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): 40 METHOD OF TEST AIR S._SyQ\S-lD(�t�EQ' -- D IC Y.Ca
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, FormGW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

V
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CEP.TIFICATION#
1.WELL CONTRACTOR: ` I. DISINFECTION:Type Amount
g. WATER ZONES(depth):
Well Contractor(ktdtvWual)Name. From, To - From To
x` 'A Ay% (t)g L A r 11 1' I A! 1 From T- From To
Weil Contractor Company Name From To From To
I r
STREET ADDRESS _�g0 f A� r _ Y7 � 6. CASING: Thickness/
I� be Pit'
I Diameter Weight Ma�VC.aI
Yfl1S ,mn y.('.. Z4Q0.'� From 07 To_��Ft.—
Giry or lawn State Zip Code � From To Ft.
t. UX),_ �rS _ 6C?&? From To—Ft
Area code- phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL tD#ir r �_Ta ?A _Ft
applicable) F:on
Ft'am— Te
STATE WELL PERMIT#;rtappiicable) From To Ft
DWQ or OTHER PERMIT#(if appficabie)- S. SCREEN: Depth - Diameter S gat P Slot Size Material
WELL USE(CheckApplicable Sox) Resklential Water SuWyto From 70_Ft._in.. __ in.
DATE DRILLEDZD' 04jL_ _f from To Ft in.
if From To_Fl. in.
in.
in.
TIME COMPLETED .Z.'m0 AM❑ PM R/
9. SANDIGRAVEL PACK:
3.WELL LOCATION: ` om Depth Size Material
CITY: COUNTY�(pfp�lop__ Fr Ta Ft.
^,�.,/j' From To FL_
P11 l , DAQ c. r_sGy_ Fran Ta Ft.
(9[reat Narere,Numbers.Comm .. bGvtslCn,LOE No.. ar0€1, pCode)
TOPOGRAPHIC/LAND SETTING: .' 10..DRILLING LOG
3815pe. C7Valley ❑Flat ❑Ridge ❑Other From To
Formation Description
(check appropriate box) Q '�r
May be i I yr _ I S
LATITUDE 3 n degrees,_ minutes,seconds or IF
LONGITUDE_ _
inededmal Tsrmat IS
1,atitudelotigitudesource: OGPS oTopographicmap
(location o7 we/must tie shown on a USGS tope,map and
attached to this Iorm Anot using GPS)
4.WELL OWNER
D
OWN€R'SNAA1€ VI ?�)QtSS. .
STREET ADDRESS ybp
city State Zip Cade
Area code-.Phone number
11. RENIARKS:
S.WELL DETAILS: k4w Il 139 CIO n� 4(w 14 r A S
a TOTAL DEPTH: �S r
In. DOES WELL REPLACE EMSTINGWELL7 YES p- NOD �aT R�4 &ARih map cn"7 Xn,r/I-
c. WATER LEVEL Below Top of Casing: )W FT. 1�N HEREBY
CERT1FY THAT AC WElLCONST TRr.WELL WAS
ARDSSTRUCTANoTH0.TN COPYOD ICE WITH
(Use"�'tl Abwe Tap of Cast HM
rig) HECORD WV S BEEN PROVIDED To THE Wrt'.OWNER.
1. TOP OF CASING IS _ FT.Above Land Surface'`Top of casing terminated at/or below land surface may require ATUI`2E O CE�tT FlED CONTRACT OR • DATE
a variance in accordance W th 15A NGAG 2C.0118.
tgpml: , METHODOFTESTAi? �).LVI �i��/tSOJ�
PRINTED NAME OF PERSON CONSTRDCTtNG THE VyELt
"Kal to the Division of Water Quality within 30 days. Attn: Information Mgt,
Inter-Raleigh,NC 27699.1617 Phone No.(919)733-7g15 ext 568. Form GW fa
.; - REa _M5

DIRESIDENTIALWELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water duality
WELL CONTRACTOR CERTIFICATION#
1.WELL tCONTRACTOR: I. DISINFECTION:Type I Amount S
C Jr m 0 4C I? �1. S evl g. WATER ZONES(depth):
Well Contractor(lndivWuat)Name From - To From
L2(41 (AL7r �Sbyl (��t dr'l��r VlQ Frrvn To From To
VV ell Contractor CompaannyrN�amme --� From To From To
STREET ADDRESS y7 7 iJ /r) r�,$pp 61 6. CASING[ Thickness!
�/ / Depth Diameter Weight Mate of
f/lGss6Grl!'f t(�i�C'i �8 �'0a2 From_{L To 77 'F-t. 6,,l Sdr2/ pi✓_C,_
Cary or Town Sfate Zip Cod? From To Ft.
( $a J- Fl 3`! - 6 4&3 From To rt.—
Area code- Phone number
2:WELL INFORMATION., ( 7. GROUT: Depth Material
SITE W ELL ID#(if applicable) Frotn�_To�'
From 3,. To ad,. Ft bk
STATE WELL PERMIT#(n applicable) From To Ft.
DWQ or OTHER PERMIT*(f applicable} S. SCREEN: Depth Diameter $lot Size Material fI
WELL USE(Check Applicable Box): Residential W ater Supply&9 From Ta Ft._in, _in. t
From To Ft._in, in: II(DATE DRILLED I!S-/.j -Q C
From To R. in. is
TIME COMPLETED!LL$ AMD PM 3- —
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: ✓V(fjr (l COUNTYe r�Kpp From. To Ft.
From To Ft.
iQL1r'+ccMo �r L �.r IOlf
From To Ft.
fSt[aet Name.Numbers, ommunit, Su6dmswn,Lot N ..Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Slope OValley ❑Flat ❑Ridge ❑Cther From o m T F rrrtation Descri tbn
(check appropriate box) ro . . P
LATITUDE 3 May 1>e,to de onreiMqs or 161
mmutcs sec
LONGITUDE inadecimzifumiar SQ &6�!
Latitude/longitudesotnce: COPS ❑Tapogaphicmapp _
(location of we®must be shown on a USGS food,map and
attached to Moil to=fndt using GPS)
4.WELL OWNER ���� " ��
OWNER'S NAME 41,ttl e_
STREET ADDRESS ,—
�ift^Dl1a/ A/ r �
Clh —Stete. Zip Oode
I g16r ) S/g4- a3o y
Area code- Phone number
5.WELL DETAILS: 11. REMARKS:
a. TOTAL DEPTH: Z&6 ,
b. DOES WELL REPLACE EXISTING WELL? YES O NO g-
c. WATER LEVEL Below Tap of Casing:_pts ' FT I DO HEREBY CERTIFY THAT THIS WELL WAS CCNSTRVCTED N ACCORDANCE WITH
1SA NCACZC,WELL CONSTRUCTION S TAMOAROS,AND THATA COPY OF TWS
(Use'+^d Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP p CASING IS e FT Above Land Surface` nt )
'Top of casing terminated atlor below land surface m I ` ' "'� 12,may equire gl ATURE OF CERTIFIED WELL CONTRACTOR OR E
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD 40 METHOD OF TEST I r t
PRIN?ED NAME O PERSON CONSTRUCTING THE WELL
Submit the originatto the Division of Water Quality within 30 days. Attn: Information Mgt.,
1Cet7 Mail QPrVIf`rs C§r5fcf-Rs[ainh Nf`,77f,49^1rIT Phnnahrn (4tUt 7'i't-7n14 arf SRR . .Form GW-Is

REsiDE.VTIAL WELL coNs7 RUCTrox REcoaD/ k v'
t>ak 2� North Carolina Deparment of Environment and Naturat Resources Division of Water Quality
WELL CONTRACTOR CERTIFICATION#. .2y6)4-I
I.WELL CONTRACTOR: I. DISINFECTION:Typa_1 e, a mount 3
t ( 1 Sn g. WATER ZONES(depth):
Well Contractor(Indlwdua()Name. Frain To
From To.
From To From Te
WelliContractOr�C pany Name From To From
yy pppp� To
STREET ADDRESS :J O[l ��r�$Qn Rd 6. CASING: Thickness/
�"lOo2 _0 eot rl 6`/r R. Diameter
11L[ St atedN
lG55�6 {7 N I Fom To
City or Town State Zip Code From To Ft.
L Qk)-_ cu 7- b CY e 3 From To__Ft.
Area code- Phone number
2.WELLINFORMATIQW 7. GROUT: Depth Ma anal Methcd.
SITE WELL ID#(if applicable)
Flom—_�_To.7Ct. fi
STATE WELL PERMIT#(a applicable) From To Ft.
DWQ or OTHER PERMIT#('rf applicable) 8. SCREEN: Depth Diameter Slot Size Material I
WELL USE(Check Applicable Box): Residential Water Supply.❑ FrrnR To_Ft._m. _in.
DATE DRILLEDh Z- '�s From To Ft._in. _in.
'
�' L From To FL in. _ in.
TtMECOMPLE7FA (nZ,l�(� AMP PMr
S. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY:W I r(�{�1y / COUNTY P f� 4 From To FL
'—��---- t From Tc Ft
From To Ft.
,Sleet Nam
e.Numbers, m Comunay,SubtlMswn,L.ot Na.,Parcel,Zip Code)
TOPOGRAPHIC f LAND SETTING: 10.DRILLING LOG
[]Slope ❑Valley. ❑Flat CRidge ❑Other From To Forma4on Description
(check appropriate box) I O I p
LATITUDE 3. — May be in degrees, tr)r 7 _.
minutes,seconds or ti.._�Q.�
LONGITUDE in a decimal fbrmat
Latitudellongitudesottroe: COPS ❑Topograohicmap
(location of we®must be shown on a USGS tops map and I=,
attached to this;form rnatusing GPS) �-
4.WELL OWNER r�
I C
OWNER'S NAME�nYt1^1 ,nn
STREET ADDRESS �- r_10-I
City Or To4hr State Zip Cade
t �
Area code. Phone number
5.WELL DETAILS: II. REE6IARKS•
a. TOTALDEPTH: H61
b. DOES WELL REPLACE EXISTING WELL? YES C NOEL/
I 100 HEREBY CERTIFY THAT n. IS WELL WAS CONSTRUCTED IN ACCORDANCE Wfi}I
c. WATER LEVEL BIowTop d Casing: 48 -__FT, ISA NCAC ZC,WELL CONSTRucTvON SYANoaRDs,ANo THATATEDIN ACCORDANCE
(Use"+"if Above Fop Of Casing) RECORD HAS eEEN PROVIDED T o THE WELL OWNER. 0,THIS
d. TOP OF CASING IS I FT.Above Land Surface' 1.1�jLvylQl2 n ^ 'n_',
'Top of casing terminated allor below land surface may require 1n dL/��� fy.Z.-L+J�s
a variance in accordance with 15A NCAC 2C.0118. STGTATURE OF CERTIFIED W L CONTRACTOR' DATE
a. YIELD(gpm): I:S METHOD OF TEST r r -�,vV1�1' &n n
rrclnt tU NAM(Of PERSON CONSTRUCTING THE WELL
Submit the original to the LtiviSion of Water Qualify within 30 days. Attn: Information Mgt.,
16Y7r ail Rarvira C:aiTlct-RxlalrsR NC77f;5C_t RfT phnna N. MICA 711.7n14 art SRR Form GW-ta

, ES713ElYTIAL R EI L CaNST7tUCTION RECORD
North Carolina Depanment Of Er V itOr rent and Natural Resources.Division of Water Qu,bty
.°` WELL CONTRACTOR CERTIFICATION 4
L WELL CONTRACTOR:
t. DISINFECTION:Type}] .�1L10 AMOUM 5
vtn P< t 1 Sd5 n g. WATER ZONES
urea Connacvx{icWturduat):Naat>Q (depth):
Pont—To Frost
To
W ell COntractcr.Company Name F•cm To: Fncrn To
C�A � ,, From To From ` To
STREET ADDRESSdJt/<F'1 6, CASING;
l/ Thickness/
LU_�1'U_-- .T�t+ . —h Q_TotL� Drama r Weight Mat"
City or Town Sfate ZIP Code From T_V:L FL—--
Area �G
h �C) ft3 7-A4! Z Fran TO Ft
Area code.. PhonenutMser
2.WELL INFORMATION- 7. GROttT:. :. Dep[h Matador Mefhod. )
SITE WELL ID#(if apok,,bia) From Tc f Fty� c (EC�j
STATE WELL PERk#T#(#appk,hfa) F'�-3-' TO�_Ft. II
From To Ft.
DWQ or OTHER PERMIT#(if epp4ca le)
a. SCREEN: Depth OWMer Sid Size Material
WELL USE(Check Applicable 8kw): Resrdemial Water soppy L- Fran- To__Ft--In. —in
St
DATEDRILLED/D- g •! - FrOra To Ftin. in, --�—
"I COMPt.ETED_q-'470 AMQ PM rti]_ from To FL�iu. _in.
3.WELL LOCATION: 8. SANDIGRAVEL PACK:
Depth Size
Material.
CITY:' � �" _
( COUNTY��1 p r From Tom_Ft
. from -r,—Ft.
(Yy�"Lt��/]��.���� Fran To__.. FL "'`_--•.._..--
(�Nem°N� wuty.5ucdmsiay, tat No.,Pucel,Zp Cad®)
TOPOGRAPHIC/LAND SETTING:
❑Slope DVagey ❑FtRi ORidge.DOther 30.FRILLING LOG
(check apprupnateboa) From f[O Fomlation Description
LATITUDE 3 MaY&in degrees,
mimHd,secon7sw lot - ZGE
LONGITUDE_ itt a dccimat former •��_- Q _ 1�^----
Lalitudetlongitttde smuce: COPS OTapogtaphic map
(,OfI fthe of this st 1I shown on a USES lopo map end
aRached to this twininotusvkj GPS)
4.WELL OWNER - u
OWNER'S NAME srrlP 11 �(•(LQ T—
STREETADDRESS 090ylp2,or.. (Zcj.
Zip Code -
Areacale- Ptwne number
5.WELL DETAILS II. REMARKS:`
a-TOTAL DEPTH:_,.��5` -
b. DOESWELLREPLACEEXISTINGWELL? YES p NO g'
e. WATER LEVEL 6ekivr Top of Casing d FT r r+EaEsv ceatFr THAT nos WELL was Cp.ISTRtrciEONAc
{Use°a•d Above Top of Coring +aA W-AC zc,WELI CMVRUCTf;R s MOARoS.AM WTA COPY"PANGE Wtstt
aECCIRO HAS SEEN PRWDW TO THE WFAJ-.OW46 THE
d. TOP OF CASING IS / FT.Above Land Surfxe'..
"Top of CWN let mrnated aVor t>elpvr land suffOCe may require ,
a variance in accordance v&h 15A NCAC 2C:0118, ATURE OF.CERTIFI ED WELL CONTRACTOR
L
e. YIELD fgpm)` METi,=OF TEST t DATE
$
on
PRINTED NAM£ F PERSON CONSTRUCTING THE WELL

ti
RESIDENTIAL S�ELL CaxSTRCCTiON RECORD
s Nomh Carol na Department of£rrnr ommrnt and tdatuml Rtsourcea Division of Water va'
WELL CONTRACTOR CERTIFICATION
1.WELL CONTRACTOR:
—�a I. DISINFECTION:TyP*AhlAmountpp Amount
Contracts(InWvafuat)Nar� —
1!�WI Ir� 1 9 r� s ^ g. WATER ZONES(depth);
Web
3 Fran To .From -To
IAlijsrt.r, I.)RII (1r`1(tnc From ro Fr®m W ail Contractor ,lrn aoy Name. To
From Tc _ From ` To
STREET ADDRESS Rn i A9r�SA _ff 6, CASING;
Thickness/
�rG 41N ��1 ScCA1'1 Ftam�_ h:2AI Ft Co Deatlarns r Gl �i Material Gfy or Taw( State, Zip Code From To
Ft
�a7-. 1 �f- l�Cf tnZ Fran: To. Ft
Area code- Phone number.
2.WELL INFORMATION: T. GROUT:: Depth Material Method
SRE WELL lDR(flaPdicabk) I'Min To L FL�� �{ytry
STATE WELL PERMIT#(B app),cable) FmTt—a! ToQFLi'L„"Z_ _
From ? To Ft
D@VQ Or OTHER PERMIT*(if appikadle)
a. SCREEN: Depth Diameter S'tM Shia MaterialWELLUSE(Check Applicable Boir); R,,mt rtiet Water Suppty(ar Frosts To Ft.
DATE DRILLEDJ0-�In �6 From To Ft__in. _im
From - To Ft._ ih. in;
TIME COM.PLEYEDJ D i fl(A AM:p"PM ram'
3.WELL LOCATION. 9. SANDIGRAVEL PACK:
Depth Size Material
CITY:.1'VIUf p_ . . COINTY�pf(I�,pA From To FL
Fram Ta Ft.
(9ireetNumbara.Caamuaey,Subomswn.LotNo.,Parcel:Zip Coca) FL
...
TOPOGRAPHIC I LAND SETTING: - -
❑Slope ©Va9ey GFW ORidge pother 10,DRILLING COG
From To
(�kapprapnak ooz) © �� Formation De6raiptmn
LATITUDE 3 May a in degrees, _� :1 O,
in aae i at for a
LONGITUDE - inadecintat tomiar (Cl` - 345
Iatitudetiongitadesource: ❑LIPS oTopographicmap '—'--'-
Axaticn of tre➢musi be shorn,w a USES fepo Map and
attached to this tam dAX usarg.GpSJ ;1..
4.WELL OWNER
OWNE 'SNAME�n�cIC "Tt'rP rPf�STREET ADDRESS
udy a town S kZip Code CA
( 'tAlo }ss4-' �olq-
Areacode- Phone number r
S.WELL DETAILS: 11. REMARKS: I ,•J. . _
a. TOTAL DEPTH: ;Sq!S
tr. DOES WELL REPLACE EXISTING WELL? YES p NO
C. WATER LEVEL Below Top of Casing: IO FT. iDoKREevCERTSY THAT T SWEUWAScaismuclEaunccoRoaNCEwtsx
(tl5e"+•.rfAbove Top of Casing) .. 1RECORp/US BEENPONSTRUCTIONSTANDARDS•ANb THATAC6F QrF g
RO✓OW TO THE WELL OWNER..
d. TOP OF CASING IS l FT,Above Land Surface` 1
'Top of casktg tartiwated alla below land surface may require an A a
a variance in accordance with 15A NCAC 2C at ItL S TttRE OF CERTiFtED WELL CON7'.RA p W-qoT�
e. YIELD(gpm)'­1'G _METHOD OFTEST L � `ryr�1W1\I
PRINTED NAME FP ERs N CONSTRUCTING THE WELL

53 r 4 9, I.
RESIDENTIAL WELL CONSTRUCTION RECORD r � � 1
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION p 3327
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 10O PPM
CALVIN ROSE g. WATER ZONES(depth):
Wet Contractor(Individual)Name From 220' To 1 1/2gpm From To
ROSE WELL DRILLING From 270' To 4 gpm From To
Well Contractor Company Name From To From To
STREET ADDRESS 7621 NEW HWY.68 G. CASING: Thicknessf
MADISONVILLE TN 37354 From 0' °Tot3B Fl DI,'mreter tnsglY Material
City or Towri State Zip Code From To FL
4( 23 )_442-3431 From To Ft.
Area erode- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
From 0 To 20' R. CEMENT GRAVITY
SITE WELL ID/(if applicable) From To R.
STATE WELL PERMIT9(dapplicable) From To Ft.
DWQ or OTHER PERMIT#(I applicable) 8. SCREEN: Depth Demeter Slot We Material
From To Ft. in. In.
WELL USE(Check Applicable Box): Residential Water Supply ElFrom To FL—in. _ In.
DATE DRILLED 12/27/05 From To IL in. _ in.
TIME COMPLETED 12,00 AM 0 PM
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Sae Material
CITY: MURPHY COUNTY CHEROKEE From Tc FL
From To Ft.
147 HOLLYBERRY DRIVE From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
[]Slope ❑Valley ❑Flat ®Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 15' DIRT
LATITUDE 3 5 00.687N Meybcin&g., 15' TO 38' BLUE SLATE
minutes,aeamda or
LONGITUDE 8 4 04.506W in decimal format 38' TO 260' BLUE SLATE
-- 260' TO 280, WHITE MARBLE
Latihxle/longitude source: MGPS ❑Topographic map 280' TO 300' BLUE SLATE
(location of wet must be shown on a USGS topo map and
attached to Ahls torm/not using GPSI
4.WELL OWNER t
OWNER'S NAME WAYNE O'BRYON t
STREET ADDRESS 601 JUNIPER PLACE RECEIVED
WELLINGTON FL 33414 cn
City or Town State Zip Code rT O
( 561 1.793-8409 jAN J '
2066
Area code- Phone number
1 1F�ft�VP VRegional Office
5.WELL DETAILS:
a. TOTAL DEPTH: 300'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO IN
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDArICE WITHc. WATER LEVEL Below Top of Casing: 80 FT. 1M NCAC M,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+-i Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface' 61 2ttiA� ��`, 12/27/05
'Top of casing terminated at/or below land surface may require SIGNATURE OFCERTIFIED WELL CONTRACTOR DATE
a variance it accordance With 15A NCAC 2C.0118.
e. YIELD(gpm): 5112 METHOD OF TEST AIR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-ta
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7105

I
p„a SrATFa .
Q RESIDENTIAL WELL CONSTRUCTION RECORD 4
A
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 31 L I
1.WELL CONTRACTOR: \ ` I. DISINFECTION:Type Amount
g. WATER ZONES(depth):
Well Contractor(Inddiivi a Name From_1�To From To
��,' ('PVC �pi Fromr7�an To From To
Well Contractor-' om�pan/y�N/Ia�me ` From To From To
STREETADDRESS 14�ta f i.Q('♦ 6. CASING: Thickness/
`` -- Lift
T= Depth Diameter Weight Material
�� a From�_To-I�Ft. LI Thin . P 1)
City or Town State Zip Code From To FL 6�._.1
L)Ne) ill/4 L . K ;_ From To Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL ID#(if applicable)_ FromiToab_Ft.
From To Ft.T C eKDeA --
STATE WELL PERMIT#(Happlicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) B. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply❑ From To Ft.—in- _ in.
DATE DRILLED — —A From To Ft—in. —_ in.
yTj From To Ft—in. _ in.
TIME COMPLETED AM D PM❑
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: a L_%_ro .lam_ COUNTY AN 2M) a From To Ft.
' Y�1 w ��iN� r �Q� Ftan To Ft.
(Street Name,Nu .Community,Subdmaion, of No.,Parcel,Zip Codej
TOPOGRAPHIC/LAND SETTINGi 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ge OOther From To Formation Description
(check appropriate box) h - �Q
LATITUDE 3 FM�ayTi�
ees, /AA 1 3�ds_,LONGITUDE rmat );3/A 1 115--- }C
Latitude/longitude source: ❑GPS ❑Topographic map —-�---'
(location of well must be shown on a USGS topo map and
attached to this form d not using GPS) _.
4.WELL OWNER `
OWNER'S NAME_ L e�yi
STREET ADDRESS c'3 / ijL
Ul
City or TEWTt a Zip Code
Area code- Phone number
5.WELL DETAILS: 11. REMARKS:
a. TOTAL DEPTH: 31605
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
c. WATER LEVEL Below To Of Casing: /- I DO HEREBY CERTIFY THAT TMS WELL WAS CONSTRUCTED IN ACCORDANCE Wml
P 9 FT. I NCAC 2C,W EI,L CONSTRUCTION STANDARDS.AND THAT A COP)(OF THIS
(Use-+^K Above Top of Casing) RECORD HAs BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS_Q FT.Above Land Surface-
'Top of casing terminated allm below land surface may require SIGNATURE OF C IFIED WELL NC�TRAC_TOR DATE
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm):�_METHOD OF TEST w
PRINTED NAME OKOtONC T L
Submit the original to the Division of Water Quality Within 30 days. Attn: Info ation Mgt.,
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 56 FORD GW-1
JAN 30 20FORDRev.7/05
Asheville Regional Office
Aquifer Protection

RESIDENTL4L wmi co1Nsmucnm REcoRD
sfT�s' 's
r ?. North Carolina Department of Environment and Natural Resources-Division of Water Quality
1
�! WELL CONTRACTOR CERTIFICATION# 3(3I
1.WELL CONTRACTOR: f. DISINFECTION:Type T/-f Amoun)C OZ
La R D% l(O-r& g. WATER ZONES(depth):
Well Contractor(Individual)Name From_,U_'�L_To From 3 To / CRM
.5Y62S a)eu SNC. From 35 To G�[65AH' From To
Well Contractor Company Name I / FromAk - Tomn, From To
STTR l�EETADDRESS 267 3Ll/� A
jDrc l&-Il S. CASING: Thickness/
?/2 C V" /C 6r 3o,S1 From 0 Two_FL ot�ter
_ S�2u IMYc al
City or Town Slate Zip Code Fran��9 Toiy4 FL 4' /8 JQ Z/ f;'YG
7t Q& )- 7C/5_z/6 r, Fran To Ft.
Area code- Phone number
7. GROUT: Depth Material Method
2 WELL INFORMATION: From (3 Tq,&9 Ft ('r'-u r C'�Re%!?4
SITE WELL ID#(if applicable) From TO Ft.
STATE WELL PERMIT#(if applicable) Fran To Ft.
DWQ or OTHER PERMIT#(d applicable) & SCREEN: De
pth Diameter Slot Size Materiel
WELL USE Check ` � From To FL in. _ in.
( Applicable eaq: Residential Water Supply Ly- From To Ft_m. in.
DATEDRILLED From To Ft—in. in.
TIME COMPLETED AM 0---PM❑ 8. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth size Material
-
CITY: R .CC-2 COUNTY C/-{61ft-EE Fran To FtFr«n To Ft `
/L(c oi2Y� I..3 ! From To Ft �D
(Sheet Name,Numbers,Community,Sub"sien,Lot No.,Parcel,Zip Code)
t�
TOPOGRAPHIC/LAND SETTING. 10.DRILLING LOG
❑Slope ❑Valley []Flat ®ifte El Other From TO Formation Description
(check appropriate box) O - 3, �� a f"
LATITUDE/t/�059. �04' man, - 69 f3iNK C/A✓
in a decimal format azpX� GCA
LONGITUDECOO N / D /NK wJ
Latitude(longitudesource: a14S ❑Topographic map 0 /!o amwe Aa%aN Mffw 'eC
(bcatbn of we@must be shown on a USGS topo ma SROW 6V" ./YAJF&
attached to this form►not using GPS) JL'
4.WELL OWNER
OWNER'S NAME
S�TRRE�ET�ADDRESS y / I�/GI<D7L5r�2NF 3eS �QA_✓ l
City or state Zip Code
(&ZR. - 36,1-3�95'o
Area code- Phone number
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH:^� O/ /
b. DOES WELL REPLACE DUSTING WELL? YES❑ NO a
I DO HERF.Sy CERTFYTHATTHIS WELL WA UCTED N ACCORDANCE WRH
c. WATER LEVEL Below Top of Casing: J v FT. ISA N C wEu== ELL
,AND THATA COPY OF THIS
(Use'+"d Above Top Of Casing) RE 0 fIEENNERd. TOP OF CASING IS dFT.Above Land Surface' L_..�L�]pLI�L�
'Top of casing terminated aVor below land surface may require ATURE OF CERTIFIED W E DATE
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): ,�METHOD OF TESTA& IDPRINTED NAME OF PERSON ONSTRUC I LSubmit the original to the Division of Water Quality within 30 days. Attu:Information 9L, JAN 30 `1617 Mail Service Center-Raleigh,NC 276994617 Phone No.[phone]ext568. RevAsheville Regional Aquifer Proterki

RESIDENTIAL WELL CONSTRUCTION RECORD ry
y / North CarolinaUcpartment of Environment and Natural Resources-Division of Water Quality
w
WELL CONTRACTOR CERTIFICATION# 3368
Fl-WELL CONTRACTOR: FF54
CTION:Type CHLORINE Amount 100 PPMLIAM BRADLEY LEWISommorame ZONES(depth):To 560' FromToEROKEE WELL DRILLINGCordrador Company Name TO From ToTo From ToEETADDRESS PO BOX 1007
Thickness/
MURPHY Depth
NC 28906 From 0' To 70' R bPlAmeter
City w Tovm State Zip Coda 1�tl
From To FL
8( 28 1_ 837-_m From To
Area code- Phone number D'
2.WELL INFORMATION: 7. GROUT: Depth Material Me6od
SITE WELL ID 8(0 applicabla) From 0' To 20_D. CEMENT GRAVITY
STATE WELL PERMIT as From To Fl
9( pplicable) Fro
To Fl.
DWQ or OTHER PERMIT#(it applicable)
8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply® From To_Ft__in in
DATE DRILLED 12 I3105 From To__ in.R._In. — in.
—�-- From To__Ft._in. __TIME COMPLETED AM PM
3.WELL LOCATION: 9. SANDIGRAVEL PACK:
CITY: MURPHY COUNTY CHEROKEE From Depth size Material
To__FL
HIDEAWAY MTN. 166 SQUIRREL RIDGE DR. From To__Ft.
From To FL
(Street Name,Numbers,Q Ivnunitg Subdimsion,Lot No.,Parcel,Zip Cade)
TOPOGRAPHIC/LAND SETTING:
§QSlope ❑Valley ❑Flat ❑Ridge pother 10.DRILLING LOG
(Check appmpriale box) From To Formation Description
May pia Mgias 0' TO 20' BROWN RED DIRT
LATITUDE 3 5 02.294N minutes,eaconds or 20 TO 40' BROWN TAN SLATE
LONGITUDE_84 13.939W ina decimal ramaL 40' TO 60' TAN TO BLUE SLATE
Latitude/longitude source: POPS ❑Too a hic ma 60' TO 70' DARK BL E SLATE
(bcaran of we'must be shown on a USGSfo p p 70' 70 605' sUTE
ellached to the form lint usng GPS) Po map end
4.WELL OWNER
3
OWNER'S NAME GALEN GENE GELONEK
STREET ADDRESS 166 SQUIRREL RIDGE DR-
MURPHY NC P8906 -------------------
-.
City or Town State Zip Code r T
82( 8 t-494-4801
Area code- Phone number
5.WELL DETAILS: 11. REMARKS:
a. TOTAL DEPTH: 605'
b. DOES WELL REPLACE EXISTING WELL? YES p NO
C. WATER LEVEL Beim Top of Casing: 100 FT I DOHEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE W@t
(use'+^iAbove Top of Casng) 15ANCACM WELL CONSTRUCTION STANDARD$AND THATA COPYf THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface•
'Top of casing terminated ayor below land surface may require "" 1�7T) ✓,7%////!i -'AY//K.J 12/14/05
a variance in accordance wigs 15A NCAC 2C.0118. SIGNATURE OF CERTIFIV WELL CONTRACTOR DATE
e. YIELD(gpm): 2 METHOD OF TEST AIR It „),k ?)Mt)1S:V `,,,Eu(lC
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division Of Water Quality within 30 days. Attn: Intormarlon Mgt,
1617 Mail Service Center-Raleigh,NC 276994617 Phone No.[phone] ext 568.
Form GW-ta
Rev.7/05

I
21059,
RESIDENTIAL WELL CONSTRUCTION RECORD
y, � North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3368
71.WELL CONTRACTOR:
L DISINFECTION:Type CHLORINE Amou t 100 PPM
LIAM BRADLEY LEWIS
Contractor(IndMduag NaDIe 9. WATER ZONES(depth):
From 220' To 240' From To
CHEROKEE WELL DRILLING From 400' To 420'
Well Contractor Company Name From To
From To From To
STREET ADDRESS PO BOX 1007 6. CASING:
Depth Thickness)
MURPHY NC 28906 From 0' To 70' Ft, gp Wter 1W80M Material
City or Tovm State Zip Coda From PVC
8828 )- 837-8008 To D.
Area code- Phone number From To Ft
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL ID Of applicable) From O' To 20' Ft CEMENT GRAVITY
STATE WELL PERMIT#(g applicable) From To Ft
From
To R.
DWQ or OTHER PERMIT#(if applicable)
8. SCREEN: Depth Diameter Slot Size WELL USE(Check Applicable Box): Residential Water Supply k] From To R.__In — in Material
DATE DRILLED 12116/05 From TO R. in
in.
From To R._in. in.
TIME COMPLETED AM PM L]
3.WELL LOCATION: 9. SAND)GRAVEL PACK:
CITY: MURPHY COUNTY CHEROKEE From Depth To Ft. size Material
OUTLOOK RIDGE LOT#4 From To_Ft.
(Sheet Name,Numbers,Community,Sab ,.bn,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC I LAND SETTING:
®Slope ❑Valley ❑Flat ❑Otlrer ORid9 a 10.DRILLING LOG
From To
(check appropdale box) Formation Description
LATITUDE 3 5 09.386N 1"Uy bein degas, 0' TO 20' RED/BROWN DIRT
mirmim,seconM or 20' 70 40' BROWWiAN DIRT
LONGITUDE_84 15.864W in a decimalrcrmat 40' TO 60' BLUESLATE
Latitude/longitude source: FiGPS 60' TO 70' DARK LUE SLA E
❑Topographic map 70' TO 605' DARK BLUE SLATE
(location of Wei must be shown on a USGS logo map and
attached to this loan Anot using GPS)
4.WELL OWNER
OWNER'S NAME ZEPHYR OUTLOOK,LLC
STREET ADDRESS 5157 EPPING LANE
ZEPHYR HILLS FL 33541 City or Town State Zip Coda
8( 13 l-997-3883
Area code- Phone number (=
6.WELL DETAILS: 11. REMARKS:
a. TOTAL DEPTH: 605'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
C. WATER LEVEL Below Top or Casing: 75 I DO HEREBY CERTIFY THATmnS WELL WAS CONSTRUCTED IN ACCORDANCE Wmt
(Use'+•9Above TO ofCasin 1ECORD HAS WELL COVIDED TOTHrSTANDARDS OW,AND IHATA CORYOE THB
P 9) RECORD HAS BEEN PROVIDED IOTHE WELL OWNER.
d. TOP OF CASINO IS 1 Ff.Above Land Surface' ..��/ 7
'Top of casing tenminated actor below land surface may require "'' 7--- �n �yli/ /�/� 12/27/OS
a variance In accordance with 15A NCAC 2C.0118. SIGNATURE OF CERTIFIED LL CONTRACTOR DATE
e. YIELD(gpm): 20 METHOD OF TEST AIR LL„I A
PRINTED NAME OF PERSON CON RUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt,
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Form GW-la
Rev.7M5

l\ESIDENTIAL WELL CONSTRUCTION RECORD
North Camkna Department of Environment and Natural Resources-Division or Water Quality
WELL CONTRACTOR CERTIFICATION# 3327
1.WeN
L CONTRACTOR: L DISINFECTION:Type CHLORINE Amount 100 PPM
LVIN ROSE
Contractor(IndMdual)Name 9. WATER ZONES(depth):
Fram 500' To 550' From To ROSE WELL DRILLING From
Well ContraUor To From To
Company Name From To
From To
STREET ADDRESS 7621 NEW HWY.68 S.
CASING:
epthD Thickness/
MADISONVILLE TN From From 0' DTo 35_R.ti er Mater�l
City or Town Slate Zip Code From To F'VC
4L 23—)- 442-3431 From To Ft
.
Area code- Phone number R -
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL ID#(if applicable) From 0. To 20_R, CEMENT GRAVITY
STATE WELL PERMIT!(itapPlicahle) From To Ft.
From To
R.
DWQ or OTHER PERMIT R(if apprxeble)
8. SCREEN: Depth Diameter Slat Size Material
WELL 115E(Check Applicable Box): Residential Water Supply© From To_R._aL in
DATE DRILLED 12/23(05 From To_Ft._in. in.
From To R._in. in.
TIME COMPLETED 10:30
3.WELL LOCATION:
9. SAND/GRAVEL PACK:
DepthCITY: MURPHY Size Material
COUNTY CHEROKEE From To__FL
OUTLOOK RIDGE LOT#27 From To__Ft.
(Steel Name,Numbers,Community,SubdiNsion,Lot No.,Parcel,Zip Code) Fran To__Ft.
TOPOGRAPHIC/LAND SETTING:
IDSlope OValley ❑Flat []Ridge []Other 10.DRILLING LOG
(check appropriate box) From To Formation Description
0' TO 5' DIRT
LATITUDE 3 5 09.462N May be r"��'• 5' TO 35' GRANITE
minute,=d,a
LONGITUDE-8 4 15.769W in a dcc mal famat 35' TO 700' GRANITE
Latitude/longitude solace: In GPS []Topographic map
(location of wet must be shown on a USGS tope map and
a#ached to this Polar InoI usilg GPS) -,
4.WELL OWNER C—
OWNER'S NAME ZEPHYR OUTLOOK,LLC •�
STREETADDRESS 5157EPPINGLANE t
W
ZEPHYR HILLS FL 33541 _
City a Tovm State Zip Code m
81( 3 - 997-3883
Area code- Phone number—
S.WELL DETAILS: 11. REMARKS:
a. TOTAL DEPTH: 700'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 0
C. WATER LEVEL Below Top of Casting: 110 I Do HEREBY CERTIFY THAT THIS WELL WAS CONSIRMED IN ACCORDANCE Wm1
(Use �' tSANCACAS BELLCOViDEDTIOHESTANDARDSEVW, 1NDIHATACW'OFlH13
( Above repaca:mg> RECORD HAS BEEN PROVIDED IO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface-
'Top of casing terminated a0or below land surface may require —'f F�✓I 7'-1� 12127/05
a vararrce in accordance With 15A NCAC 2C.0118. /SIIG_NATURE OF CERTIFIED WELL CONTRACTOR DATE
V
e. YIELD(gpm): 1 METHOD OF TEST AIR iukk� Rom! SF
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality Within 30 days. Attn:Information Mgt,
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 588. Form GW-1a
Rev.7/05

RESIDENTIAL WELL CONSTRUCTION RECORD 1 0 L
North Cambne Ue partrnent oTtnvironmen[and Natural Resources-Division of Water Quality
--. WELL CONTRACTOR CERTIFICATION# 3368
1.WELL CONTRACTOR: E DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LENS g. WATER ZONES(depth):
Wet Contrador(Individual)Name From 260' To 280'
CHEROKEE WELL DRILLING From To
Fran 360' To 380' From To
Well Contred«Company Name From
To From To
STREET ADDRESS PO BOX 1007 S. CASING: Thickness/
NC 28906 Depth D Wiel
MURPHY From 0' To 50' R 6 aa� ; rPvV�C
City«Town State Zip Cafe From To R.
8( 28 1- 837-8008 Fran Tc Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL ID rT(if applicable) From 0' To 20' Ft. CEMENT GRAVITY
From To Pt
STATE WELL PERMITI(l applicable).
pplicable) From To R.
DWQ or OTHER PERMIT#(If apprimble) B. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply® From Tc R._in _ in
DATE DRILLED 12JI9105 From To R. In. in_
From To R, in. in.
TIME COMPLETED AM� PM Cl --
9. SAND)GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From To From To Ft-_Ft.
OUTLOOK RIDGE LOT#/3 From To Ft.
(Strew Name,Numbers,Canmundg Suhdlwslon,Lot No Parcel,Zip Code)
TOPOGRAPHIC!LAND SETTING:
®Slope OValk 10.DRILLING LOG
Y POrw�irate bOmRldge ❑Ofh« From To Formation Description
(checks ) 0' TO 20' RED CLAY TO BROWN SLATE
=dQiml
LATITUDE 3 5 09.579N 20' TO 40' BROWN SLATE TO BLUE SLATE
LONGITUDE 84 15.883W 40' TO 50' BLUE SLATE
50' TO 405' BLUE SLATE
I,atitude/longitude source: F9GPS ❑Topographic map
(location of wel must be shown on a USGS fipo map and
attached to this firm loot using GPSJ
4.WELL OWNER <--
OWNER'S NAME ZEPHYR OUTLOOK,LLC
1
STREET ADDRESS 5157 EPPING LANE
ZEPHYR HILLS FL 33541
Cry or own state Zip Code
( 813 1_997-3883
Area code- phone number
S.WELL DETAILS: 11. REMARKS:
a. TOTAL DEPTH:405'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOIH
C. WATER LEVEL Below To dCas'ng 75 FT I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACWRDANCEWNH
P . 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+"i Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface'
'Top of casing terminated at«below land surface may require //L � 12J27/DS
a variance n accordance with 15A NCAC 2C.OiIs. 'SIGNATURE OF(�E TI L CONTRACTOR DATE
a YIELD 20 METHOD OF TEST AIR L61LLI�L< (�R;�c�tP1� \
PRINTED NAME OF PERSON ON�STKLIL;[ G THE WELL
Submit the original to the Division Of Water Quality within 30 days. Attn: Information Mgt,
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Form GW-la
Rev.7105

,arA2: RESIDENTIAL WELL CONSTRUCTION RECORDX 3) 210 IS 8
North CamfinaDeparhnent of Environment and Natural Resources-Division of Water Quality
. . WELL CONTRACTOR CERTIFICATION# 3327
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
CALVIN ROSE g. WATER ZONES(depth):
Web Cordractor(Individual)Name From 365' To 370'
From To
ROSE WELL DRILLING From To From 70
well Contractor Company Name From To
From To
STREET ADDRESS 7621 NEW HWY.68 S. CASING: Thickness/
MADISONVILLE TN 37354 Depth p,�r�eter W Ma let
From 0' To 71' R. 6 7/tl Sa�M 2t F'VC:
Cdy or Town State Zip Code From To Ft.
42( 3 )-442-3431 From To Ft.
Area code- Phone number —
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SITE WELL ID i(I/applkade)
From 0_To 20 R_ CEMENT GRAVITY
From To FL
STATE WELL PERMITR(i applicable) From To Ft.
DWQ or OTHER PERMIT f(t applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply® From To R._in. _ in.
DATE DRILLED 12/26/05 Frorn To Ft._in. _ in
TIME COMPLETED 12:00 AM p PM RI
From To Ft. in. In
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
OUTLOOK RIDGE LOT#16 From To Ft.From To FL
(Street Na..,Numbers,Communay Subdiwslon,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑F)at ®Ridge ❑Other From To Formation Description
(check appmpriate box) 0' TO 35' DIRT ��
May be in dc�ecs,
LATITUDE 3 5 09.425N 35' TO 55' DIRT 8 BROWN SI-ULLE minuT®,ewonda or
LONGITUDE_84 15.738W in adecimslfmmat 55' TO 71' GRANITE
LafitudeAOngitudesource: P]GPS ❑Topographicmap 71' TO 400' GRANI E
(bcabbn of we/must be drown on a USGS tope map and
attached to this Ibrm trial using GPS)
4.WELL OWNER
OWNER'S NAME ZEPHYR OUTLOOK,LLC
STREET ADDRESS 5157 EPPING LANE
ZEPHYR HILLS FL 33541 — -
Cay or Town State Zip Code -
8( 13 1-997-3883
Area code- Phone number
S.WELL DETAILS 11. REMARKS: --
a. TOTAL DEPTH:400'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO Di
C. WATER LEVEL Below Top of Casing: 130 FT I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use'+•f Above TO dCasln IM NCAC2 ,WELL CONSTRUCTION STANDARDS,AND THAT A COSY OF THB
P g) RECORD HAS BEEN PRODDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface' �///� /n/,�
-Top of Casing leminated aVor below land surface may require LZTi4r'J ''t `� 12127/05
a variance in acwrdance with l5A NCAC 2C.0118. SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 20 METHOD OF TEST AIR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt,
1617 Mall Service Center-Raleigh,NC 276994617 Phone No.[phone] ext 568. Fomn GW-ra
Rev.7/05

I
1' RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: L DISINFECTION:Type CHLORINE Amount 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individual)Name From To From Tc
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
MURPHY NC 28906 From 0' DTot65' R. 6p,Od WVw
City or TaAn State Zip Code From TO R.
8( 28 ) 83743008 From Tc Ft.
Area code- Phone number
7. GROAT: Depth Material Method
2.WELL INFORMATION: From 0' To 60' Ft EZ SEAL PUMPED
SITE WELL ID!(if applicable) From To R.
STATE WELL PERMITI(r applicable) From To R.
DWQ or OTHER PERMIT I(I applicable) 8. SCREEN: Depth Diameter Slot Size Material
From To R. in. _ in.
WELL USE(Check Applicable Box): Residential Water Supply I] From_To R._in. in.
DATE DRILLED 12/22105 From_To R. In. rti.
TIME COMPLETED 10:00 AMA PM❑
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CHEROKEE From To FL
CITY; MURPHY COUNTY From To FL
THE SANCTUARY AT VANCE MOUNTAIN From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
MSlope EiValley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 8' BROWN SHALE
May be in degf , 8' TO 12' RED SHALE
LATITUDE 3 minutes,secondv or
in a decimal Tomcat 12' TO 35' BLACK SLATE
mc
LONGITUDE_ _ 35' TO 285' GRAY GRANITE
Latiludeftongitude solace: ❑GPS ❑Topographic map 285' TO 303' WHITE QUARTZ
(locahbn of war must be shown on a USGS lopo map and 303' TO 505' GRAY GRANITEIWHITE QUARTZ
attached to lids firm I not using GPS)
4.WELL OWNER
OWNER'S NAME THE SANCTUARY AT VANCE MOUNTAIN
Y
STREET ADDRESS 4750 ANDERSON RD. _
BLAIRSVILLE GA 30512
City or Town State Zip Code
L 706 )- 835-6300 rn
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: 505'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: 0 FT. IM NCAC 2C,WELL CONSmUCTIDN STANDARDS,AND THATA 001r OF THIS
(Use'+'I Abate Top of Casing) RECORD HAS
BEEN PRMIDED TOTHE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface* / 1 /,/r ft 17J22t05
*Top of casing terminated atlor below land surface may require SIGNATURE OF CERTIFIED W LCONTR TOR DATE
a variance in accordance With 15A NCAC 2C.0118.
e. YIEID(gpm): 0 METHOD OF TEST AIR R `
PRINTED NAME OF PERSON CONSTRUC ING THE WELL
Submit the original to the Division of Water Quality within 30 days. Ann:information Mgt, Fomr GW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7105

RESIDENTIAL WELL CONSTRUCTION RECORD
tf /� H'
North Carolina Department of Environment and Natural Resources Division of Water Quality
�. WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: E DISINFECTION:Type CHLORINE Amount 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individual)Name From To From To
CHEROKEE WELL DRILLING From To From - To
Well Contractor Company Name From To From Tc
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
MURPHY NC 28906 From 0' Depth
100' Ft 6p ter W, rt �1;
City or Town State Zip Code From To Ft.
8( 28 )_ 837-8008 From To Ft.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0. To 100, R EZ SEAL PUMPED
SITE WELL ID 6(if applicable) From To Ft.
STATE WELL PERMITd(a applicable) From To Ft.
DWQ or OTHER PERMIT x(if applicable) e. SCREEN: Depth Diameter Slot Size Material
From To Ft.-In. _ In.
WELL USE(Check Applicable Box): Residential Water Supply© From To Ft.-in. _ in.
DATE DRILLED 12JI5105 From To Ft. In. _ in.
TIME COMPLETED AM PM O B. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CHEROKEE From To Ft.
CITY: MURPHY COUNTY From ToFt.
THE SANCTUARY AT VANCE MOUNTAIN From To_Ft.
(Street Name,Numbers,Community Subdimson,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
gSlope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 45' RED SHALE
May be in degree, 45' TO 59' GRAVEL
LATITUDE 3 _ minutes,aecondv or BROWN SHALE
in decimal format 59' TO 90'
LONGITUDE_ _ 90' TO 109 GRAY GRANITE
Latitudellongitude sauce: ❑GPS ❑Topographic map 100' TO 23Z GRAY GRANITE1WHITE QUARTZ
(location of well must be shown on a USGS tape map and 232' TO 505' GRAY GRANITEIRED a WHITE QUARTZ
attached to this Porn lint using GPS)
4.WELL OWNER
OWNER'S NAME THE SANCTUARY AT VANCE MOUNTAIN
STREET ADDRESS 4750ANDERSON RD. -,
BLAIRSVILLE GA 30512
City or Town State Zip Code
( 706 )_835-6300 C:)
Area code- Phone number
11. REMARKS:
6.WELL DETAILS: BIT SIZE: 6.043
a. TOTAL DEPTH:506
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSTRUCTED tN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: 0 FT. 16A NCAC RC,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use'+-i Above Top of Casing) RECORD HAS BEEN PROVIDED TOTHE WELL OWNER.
d. TOP OF CASING IS 2 FT.Above Land Surface' I �� 1;J WW' /�LGI/JCL/J 12122/05
'Top of casing terminated allor below land surface may require SIGNATURE O CE TI ED WELL CO RACTOR DATE
a variance In accordance with 15A NCAC 2C.01I S.
e. YIELO(gpm): 0 METHOD OF TEST AIR l 44RnmP►3Rg L. 1 )1('T
PRINTED NAME OF PERSON CONSTRU TING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, Forncw-te
1617 Mall Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7M5

1a
RESIDENTIAL WELL CONSTRUCTION RECORD 1024
`y��t✓' North Carolina Depertrnent of Environment and Natural Resources-Division of Water Quality
�.,. WELL CONTRACTOR CERTIFICATION N 2261
1.WELL CONTRACTOR: L DISINFECTION:Type CHLORINE Amount 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(individual)Name From 299 To 300' From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
MURPHY NC 28906 From 0 DTo 60' Ft bpVVer WfW �( gf
City or Town Stele Zip Code From TO Ft.
$( 28 1- 837-8008 From_To R.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 01 ToW. Ft. EZ SEAL PUMPED
SITE WELL ID*(if applicable) From To Fl.
STATE WELL PERMITS(a applicable) From TO R.
DWQ or OTHER PERMIT/(if applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply® From To Ft. in. in.
From To Ft. in. _ in.
DATE DRILLED 12/16/05 From_To Ft. in. _ in.
TIME COMPLETED 4:30 AM E) PM
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Sae Material
CITY: MURPHY COUNTY CHEROKEE Frorri-To FIL
From To Ft.
THE SANCTUARY AT VANCE MOUNTAIN From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,parcel,Zip Cade)
TOPOGRAPHIC!LAND SETTING: 10.DRILLING LOG
OlSlope OValley DEW ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 12' RED SHALE
May be in dcuca, 12' TO 27' BROWN SHALE
LATITUDE 3 _ mint®,seconds or
in a decimal format 27' TO 285' BLACK SLATE
LONGITUDE_ _ 285' TO 290' WHIT Q ARTZ
Latitude/longitudesoTace: ❑GI'S ❑Topographiemap 290' TO 315' GRAY GRANITE/WHITE QUARTZ
(locaflan of we/must be shown on a USGS topo map and 315' TO 322' GRAY GRANITE
attached to M form Knot using GPS) 322' TO 505' GRAY GRANITEANHITE QUARTZ
4.WELL OWNER
OWNER'SNAME THE SANCTUARY AT VANCE MOUNTAIN -
STREETADDRESS 4750ANDERSONRD.
BLAIRSVILLE GA 30512 -
City ar Town State Zip Code 4I
706 )-835-6300
Area code- Phone number C]
11. REMARKS: rn
S.WELL DETAILS:
a. TOTAL DEPTH:505'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
DO HEREBY CERTIFYTHATTHIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: 75 FT. I'M NCAC M.WELL CONSTRUCrx]N STANDARDS,AND THATA COPY OF THIS
(Use'+'f Above Top of Casing) RECORD HAS BEEN MOJIDF-D TOTHE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface' - j�,/L 12/22/05
'Top of casing terminated atfor below land surface may require NATURE CERTIFIED l CONT CTOR DATE
a variance in accordance with 15A NCAC 2C.0118.
e. YIELD(gpm): 10 METHOD OF TEST AIR C\YQ+\5 �V�m L• Z�K�4 �
If PRINTED NAME OF PERSON CONSTRUC ING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-ta
1617 Mail Service Center—Raleigh,INC 276994617 Phone No.[phone] ext 568. Rev.7/05

V
�d STATpa,
> 09
1r� e) N
f` . RESIDENTIAL WELL CONSTRVCTION RECORD
M. North CarolinaDepanment of Environment and Natural Resources-Division of Water Qualhr
WELL CONTRACTOR CERTIFICATION If 24 r;4
1.WELL CONTRACTOR: I. DISINFECTION.Type Amount 4
9, L".�� 1 SC1Il $. WATER ZONES(depth):
Wall corarwWr(tndtinduall Name F•om Tc From- To.
;i"'NeA1 df'j 'l i t1 Fran To Fran To
Well Contractor Company Name m fro - To From To
STREET.AODRESS tip. /) .Cn,-�,I 6. rAS(NG: -.. Thickriess/
ss5 ltry.q N C ���3 m2 From Depth
Diameter5 Material`60'Ft DI
City or Town" State ,Zip Code Frorn_To Ft
( iCi7- L1�u � From_To Ft.
Areacode. Phone number
2.WELL INFORMATION: 7. GROUT: :Depth Mat al Method
Fran u _ Ta - Ft: �� ' `Y 'SSLII
SITE WELL ID rHIlapplicabie) Fram Ti ' To . T' Ft. 3
STATE WELL PERMIT,#(aappi�abte) From TO -:Ft
DWQ or OTHER PERMtT#(If apptiable) It. SCREEN: :Depth Diameter SWt Size :Matend
WELL USE(Check ApPlicable Sox) .Residential Water Supply ly From_7o Ft iin.. in
From To Ft._m. Tin.
DATE DRtLLE6_- Q�� From Tri FL in.:. I,
TWE COMPLETED I CJ%CCi AM Ly PM 0
S. SANDIGRAVEL PACK:
3.WELL LOCATION: depth Size Ma's.
CITY. A nj r()v l S COUNT+IC_j.,Ae From To Ft
Fran To Ft
Ls tJ, �ti_p�i3Lf{ 5�� Fran To FI,
t54aa.Mame,NumWl's,CammunRy.Subdwmoon,Lot Na. Parcel,Zip Coda)
TOPOGRAPHIC I LAM SETTING:: - tO.tN?rLLING LOG❑slope pvalley OAat t7Ridge ❑Omer ,Fr 1(Jm
T o DrtrRtlon Description
(at"appropdatehux) 1
LATITUDE 3 May be indegrees, l r
mirartes,secoDds or —F*
t lot_
LONGITUDE in a decnoat farmst 11 r 10
Latitudet'longitude smirae. pGPS OTopographic map
{,ocafixr of W"masl be sfovm on a USGS tom map and - I
attached to iM1ts Al Jim?aserg.GPS).
4.WELL OWNER s�
OWNER'S NAME
STREETADDRESS.
City or Town State Zip Cade
Area code- Phone number
-11. REMARKS:
S.WELL DETAILS:
$ TOTAL DEPTH:
In. DOES WELL REPLACE EXISTING WELL? YES Q No a;--
G. WATER LEVEL 6elOrr7 Ot C8a1 .: DO HERESY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WRN
n FT.F 15A NCAC 2C,WELL CONSTRL/C7ii5N STANDARDS,MID THAT ACOPY OF TM
(Use'+'if Above Top of Catskill). RECORD WZ SEEN enOVOW TO THE WELL OWNER
d. TOP OF CASING is 1 FT.Above Land Surface' ���� � t2 r ( xZ� t v If Q S t�S
"Top of nosing accordance
alto below land 2C.01 may require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accadanae with 19A NCAG 2C:Ot 18.
a. YIELD P— ..: . W1P-s _ H 1 -.q
(gpmy: METHOD OF TESTA 1S1 ( L �i.1 `s rs
PRINTED NAME OF PERSON CONSTRUCTING Tt(E WELL -

RESIDENTIAL R'ELL CONSTRUCTION RECORI)
ldorh Carolina Department of Emnommrnt and Natural ReSourca-Divpsxap of Water Quality
WELL CONTRACTOR CERTIFICATION# 1,
I.WELL CONTRACTOR: f. DISINFECTION:TYPa� Amount�
, 1am(uS R. 9. WATER ZONES(depth);
Well Contractor(indwduat)Name },:: From To From—To—
.lA')j son t LINQ From To. Fran To-
W ell Contractor Company Name - From To From To
STREET ADDRESS ��].S (.tr)','tsnn „ A,, S.CASING; - Thickness/
rr,sS�nL ✓l �� {' a84ma Fran n aat fk materw
a:5- sDLi 4
City or Town Sfafe'.._ Tip Code From ..(..To - FL
( 50 V) fSz f-D�i(Q3 From To Ft. _
Area:code- Phone number
2 WELLINFORMATIOW 7. GROUT: Depth Metedal Method
SITE WELL ID#of applicable) From _©To .3' FL
From_�_To
STATE WELL PERMIT#(aapphratiie) FTtxrT To FL
DWQ or OTHER PERMIT#(rf epW—,ble) 8 SCREEN: Depth Oi smater Sid Size :Material
WELL USE(Check Applicable Box):.Res�tlenU W amr Supply gj� Fratt To_Ft—in.:.— in
From To_Ft in m.
DATE DRILLED I)_: —bS ,: From To. :. Ft.—. in..
TIME COMPL.ETED:32 3O AM.O -PMp._
9.. SANDIGRAVEL PACK: ..
3.WELL LOCATION: (.. Depth Size Material:
CITY:.�(� � COUNTY Ctippy'n A..p " From To Ft
r I From To Ft.
,mom From To FL
�ZAFwr N/rw.Nwnbers.CommwidY;Subdm*s Lot Na.Parcel,Zap Co")
TOPOGRAPHIC!LAND SETT#NG' ili.pRIWNG.LOG
❑SlopeOValley'❑Flat Cl Ridge OOdper ..From To Formation Description
(check Opprapdate box) U
May be in de8rees,
LATITUDE 3 _ mmure%swonds or (�--=�U"5� C,
LONGITUDE pq s decmrat former
LatitudeJhmgitmiesowce: OQPS oTopographicmap
(,bcabDn of welf must be shown:on a USES lope map and
erached to lhA Pomp tnor rising GM)
4.WELL OWNER
OWNER'S NAME I(I('k
STREET ADDRESS.RO, .]YN$ c7i
LoncmU
or
Town. She;..,. 7JpCode
(ti^ln )- 55 9- yo/'�
Area code- Phone number
II. REMARKS:
S.WELL DETAILS: r/
a TOTAL DEPTH:.I�S�
b: DOES WELL REPLACE EXISTING WELL? YES 0 NO
e. WATER LEVEL BelaN Top of nnr I DO HEREBY CERTFY THAT THIS WEL WAS CONSTRUCTED N ACCORDAN(:E Wmf
oP a3m9. IV FT rSA NCAC2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THE
(Use'+'rf Above Topof Casig) REOOROk 6 BEEN PROVIDED TO THE WE"OWNER
d. TOP OF CASING Ig I FT,Above Land Surface`
'Top of"Iln9 tems"ed aVor below land surface may require
a valance in ascgordance with 15A NCAC 2C.0118. SfGTTURE OF CERTIFIED.WELL CONTRACTOR DATE
e. YIELD(gpm)'_04M _METHODOFTEST,A;a— .L^1V]d8s_ .J.d7i �SC�VI -T
PRINTED NAME 01 PERSON CONSTRUCTING THE WELL

�r � 1
RESIDENTIAL WELL CONSTRUCTION RECORD , t 3
' y Nmih Ca Wrna MPartrnent of Envtmnment and Natural Resources-Divi,ion of Wgtet Qeaahtc
WELL.CCt!YTR4CTORCFRY3FICATT{7N#-,�-✓v7
+.WELL CONTRACTOR: T9.
SINFECTION:Trrmi_?ell�sscm6urrt 4
_��CtVNOG (,�`��,e.f�!'1 - ATER ZtN!£S(deph)tWall Coneactm(1RdiVYAatt)Nama _ To Frain To
..,___ F•an To—,_ From Ta
jI Well ConUactor Company Name. J Fran To__N From----
___To
STREET ADDRESS%/) (::t 7 i f,5ll. S. CASING! :. Thcknesst
''pp ���� ((�� De0i Giant to �Waiigntt �Ma"te�l
t T_t.�SlClf Ll(1 N�k �B s.CZD `rton_�,_To �7, Ft 3 S&W crs...__
' City or Town State Zip Code From_ To Ft
U<s 8� Y-bA(a� From 'To� Ft -- --,
Aiwa cod®- phone nuntx
2.WELLINFORMATMN: T. GROUT: Depth material Method
SITE WELL rD#(ff appikable) Front__V _TTo (. F tt- 1 ' L&_0 [
toS4LLce
STATE WELL FERIrITT$tq apphcaaei Fratrt To Ft, I.
DWO or OTHER PIRf.11T#(if eppucaWe) S. SCREEN:. Depth Oiereeter Slot Size Material:
WELL USE(Check Applicable Box): Residential Water Supply P.- Fes' To Ft th
!SATE GRILLED U_` -QS From - To Ft,in. —in.
From,_Tq in.
TUIECOMPI£TEtl aiQQI ... Am ?m13-
'S. SANWGRAVEL PACES:
3.WELL LOCATION: Depth Size
Clrf:. 6`llti(�AI. Cut,NT'fcjR c6t,kP From _—To _ FL__
��'Tt'- From - To Ft.
-rw 'Numbers.Cpnmw4tY.SubtlhswPt.tAt Nn..Fa+ce1.ZaP dads)
TOPOGRAPHIC f LAND SETTING: 111R DRILLING LOG
OSlope OValey OF}at ORidge, 0Other From :To n 11 Formation Desaiphon
ek(che appropriate tm) d - 1b, �yr_{(/
LATITUDE _3 May&m gSZPa' try- aS
mrmrtn,srcoRds aT
i d in a ecmal foraw
LONGITUDE
Tatitndellongiivde sovrcc; OGPB OTopographic reap
9 fkrca&n of wek must be shoem n.w a I/Sf7S tow map and -
alfaChed to inks hVm Inoros lg GPS)
4.WELL OWNER ---- - "
OWNER'S NAME
STREETADDRESS ?,O, hOX aY
r
I t�trop Ile �;{4 —
r> -a Tava stela Zip Code
Areacode- Pho
" _ yo-/9
t_ne nunrZS be,Er
II. REMARKS:
S.WF_LL:DETAIi.S:.
a. TOTAL DEPTH: tq5 k
b. DOES WELL REPLACE EXISTING WELL? YES o N04a-- _w _
e. WATER LEVEL Below Top in9:of Cas -.c Q( FT. 100 HERESY CERmrns;T MSWEuWAS conSTRUCM0 N ACCORDAME VOTN.
ISAW-A&;2C,WEUCORSTrruCMRSTSMIRRDS.nN TMTACOa OFTM
(Use`+'fl Above Top d Casing) RECORD NAS BEEN PROVM TO THE W Ell OWNER,
d. TOP OF CASING 1S I FT,Above Land Surface' rl !J (, �i�� �� bT-o
'Top of casing tarn hated allot below land surface may requae SIG ATURE OF CERTIFIED WELL CONTRACTOR DATES
A vaaiance in accordance with]SA NCAC 2C.01 is, (� _
a. YIELD(gpm):-JnQ_METHDOOFTESTA_� _:YQWI£S R La��_SQQ
PRINTED NAMEOF PERSON CONSTRUCTINGT4JE WELL

RESIDENTIAL VVE[LCO NSTRUCnONRECt)RD
a No d Carolina DEpanmedt of£nvirmttnent and Natural ResourEe D visism of w n r Qpt Ni
WELL CONTRACTOR CERTIFICATION# ;U Q(4
1.WELL CONTRACTOR: f. OtStNFECTION:TV;J . Y y
�1issew 9. WATER ZONES(depth);
Wall Con tractor(IMrwcSwil)t+6amw f From To From To
r!_� won ( ')d l d('�� Fran To�.` Fror:v To
Weil Contractor Company�Nyame. . Fron To _ From To
STREET ADDRESS 7r(7 A� r' dl Q�7 9. CASING: :: Tna;hnessl
L{I-� Depth Aiantetes Weiofit Marau
SSIO�."�771 C ` V¢�,O.Q Frain 0 Tob q ,Ft ras GVW �VC
City or Town State Zip Code From To Ft
18a4j_ t��7-cj4{AZ Fror„ ro FL
Ares Dade- phone njRv-w
2.WELL IIIFORMATtow ,. 7. GROUT: Depth MethodS(TE WELL IO N(irapplkaGN)� fm To ,3` ET.
mrh_y
FtcZ'_Ta R. l
STATE WELL PEFt MT#(a appricabie) From To Ft
DLVQ cr OTHER PERMIT#(if appkcabie) 8. SCREEN: Depth DPOnr_Wer Star Size ,. malefid �.
WELL USE(Chuck Applicable Box)! RaRZRntiai WRrw s Fran Tc Pt min, h _ W J
pM}P' Fran Ta mi Ft n. in. t
TIME
EDRILLt E ` �- (�C-r - From TO--_Ft. iir. —.in. !
TIME COMPLE TFA 11; AO AM.Lj PM per.
9. SANOIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY,Mi I cphl I GOUNTYjC.hQj"_el Fran" To FL--
' Fran To Ft.
p(�q�c-( F:ae To Ft,
t but N t,Numbers.CommurAy,Sobaiiusian,Lot Nb.,Pu L Zip Cote)
TOPOGRAPHIC/LAND t;MWG: fig.DRILLING.LOG .,
❑slope [7V9ky OF19 DRiage 00tfiar From TO F mtatidn Description
(sheds nppn*iatebox)
hI
LATRUDE 3 m,m 6e s degas, `t i- .�t
mimrterr soamdsu ��
LONGRUDE - inedecimailtanmt �`-. :S( '
Laitude 0119itnde sourm CCrPS OTdpograp}ric map
fbcafbn of w ff must be shown w a USGS topo map and -
ailscfieA:fn fires loan rnm uotg GPS)
4.WELL OWNER
OWNER'S NAME-rwork
STREET ADDRESS.Qr O. I�PtY a`r 41 - W
FCns2
OiPJ or Tovm Zip Code
Lea SSy- Ublg
ArDacade-
Ptwru number.
5.WELL DETAILS: 11. REMARKS:
a TOTAL DEPTH;is cis c
b. DOES WELL REPLACE EXISTING WELL? YES O No Oi--
100 HERESY CERAFY THAT ME WEU.WAS CONStRUCIEDM ACCORDMCt WUN
E. WATER LEVEL Below Top q{Casing. ff® t FT. 15AW-AC2C,WELL.CDNSMLICIMSTANOAROS,AF IACOMOFTM
(Use"+*it Abme TW Of Cesthg) RECORD HAS SEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CAwNG:m I FT,Above Land Surface Ya�, pQ Q t 1 i �n-
`Top or cm tg toln"ed Wa below land surface omy require g(GN TURF Op CERTIFIED WELL C TOR. DATE
$ a variance in accordance.With ISA NCAC 2C.0118.1 ``1 e. YIELD(gpmpJS _MUHOD OF TEST i VQUNIO_< W t SQl
PRINTED NAME OF PERSON CONSTRUCTING THE WELL

RESIDENTZAL WELL CONST3zurnoh c()rjy)
��r�`�„i��' Tda,^.3s Earolma Department o!'Erzrtorrmrns Bad?aatwa!iLtswirx� f}iviskm ri'Viaer CjnraEt}
i WELL;CONTRACTOR CERTIFICATION#_ ��EUCj
I 1.WELL CONTRACTOR: t. OtSiNFECTIOt:TyPe,�t
9, WATER ZONES(depth).
"Vag contractor(twivio"]Name From To From To
CW7 i`Sn n (Ati,Q� Frwn_, Ta�__ Frmn To
Well Contractor Company Name 11 From T.To—___._ From To _
STREET ADDRESS �j souo e 1 GR1!\ �� C CASING: Thrckaessr'_
w) N � � Ftvn_�
Iin. Depth Diameter "let Ma l-ru f
�l_Ce.S��f•L �g7�/ io Y°
I City or Town State Zip Code Free To rt
�Tn�ft _
Arm code- Phme nomber
Z VVEII INFORMATION: 7. GROUT: Depth mad. ai Mall.
Front -D To 3' F'L ��-�p�� ���'p
SITE WELL ID x(ir appticabls)_ Fmm-r _To,_�!_Ft. y - -.t->•d�li.l.
STATE WELL PERMPflka apptcaole) Frurn - Tn—.: Ft p
}} i
DWQ or OTHER PERMIT*(if eppkrabie)
0. SGR££N: {;depth Di®npter 5mt>aiis Matenat�
WELL USE(Check Applicable Roq Resitlesnial Water Stippiy Fmm To—Pt in, kt tFj{
From To_Ft in. __in.
DTtILi£O I[-1pFG_b�. Frcrn_�` 4n. .�in....
TUIECDMPI.ETEDJ%3lrS AM❑ PM
8. SANDIGRAYEL PACK:
3.WELL L,OAC-AT�ON_: ` Depth Size futaieriai
CITY: �Y]C.G�L-��< , COU#v`TYCr f'�O-(O from_ Ta_ Ff.__.._
from To FL
Ft: :.
(saw Narrw,Nwnimm Qwawnay, saat,Lot Nor,Parcel,Zip co")
TOPOGRAPHIC/LAND SETTING: 39,DRILLING LOG
Llslopo pcgey�r o"box)kge. ❑ON�ar Run To t Formation Deg`u0tio
oi
LATITUDE a MaY be in degrees, _ 7�Sr l '
memrte;6exo1aS5 a<
LONGITUDE ,� in sratai format
Laatodellong tulle spruce: COPS :pTupolipaphic map
(hcafrpi of wefenraat t+e sFroRm.Drr a tlSGS topo m®p end
eriached to"lbolt f ttar usrig GPS)
4_WELLOWNER
OWNER'S NAME
S�T+�T ADDRESS 1 ILL a i 9
�nr P :) c N icml -
7 1
City or down Site:. Zip Code
1 )
Area.code- Phone number
5 WELL DETAILS: II. REMARKS:
�t, �
a. TOTAL DEPTH: r>I'S
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO tf;.—
r I.'0' RESY CER:. yTHAT ran WELL WAs COWRXMD&ACC0R0V/CEWrTN
C. WATER LEVEL Below Top dCaaing- rJb IT. 15A RCAC 2C.WEU CMTRucruw STANDARDS,W)T TACO"OFTreS
(Use'+'B Above Top d cmir9). - RECORD ars BEEN PRaVIDW To THE WELL OWNER.
d. TOP OF CASING IS. _( FT.Above land Surface•
*TOP d cwkV teimalated Wor below land surface may raqu6a IED ( 1� fl-AG-0$.
a variance in accordance with 1SA NCAC 2C.0118. SIGMA�cU-RE OF CERTIFIED WELL CONTRACTOR DATE _
a. YIELD(Wm)" �METHOD OF TEST 1+4i Q _ l a Wt0-S R Irk
PRINTED NAiAE OF PEP.SON ONSTRUCTINt;THE WELL

}�4y,M15tAIE J d
RESIDENTIAL WELL CONSTRUCTION RECORf)
North Carotma Deparunent of Environment and Natum!Resourr -Drvisionc f Wat,Cpuaixv
WELL CONTRACTOR CERTIFICATION p a(40
1.WELL CONTRACTOR; t. tASfNFECTIOPt:7ype16ti{ens ,hap�m[
I WL P '�„ L J 9. WATER ZONES(depth):
W-0Contl=b r(fndmafcWJ Name.. From To From - Te _
To;_ From To
vVetl Contractor Company Name —`— f—n Frdn-_ To_, From To_
STREET ACDRESS SVt (A'ly`�Cy(Z Q� 6. CASING;. Thickrressf
sl' Depth 7rameter vveigm M*&W
li'W'7 �' 'I tr(in,J From Depth
To jjf�FL.(6,,
Oty or Town state zip Code Fr I4dlDr Ta.,.,�,0S' Ft,a_Q,_ gZL
om
1u-j- �65`�_ aLal _ From To Ft
( A,sa Fnfe- Phohenurntw
2 WELL INFORMATION: !
T. GROUP:... Depth Maieriaa Method
From
To EL 14A1. Lp-
SIT WELL SO k(rc app cab e) Ftms_y�i__Tc 1l Ft
f
STATE WELL PERMt'P#!tl applcable) fran 7o Fi
DWQar OTHER PERMIT Yi(#applicable) + S. SCREEN: Depth Dj�rneter SW.$42x Matenal II
WELL USE(Cheek Applicable Bof): Rmzenthg Water Supply fran To Ft,�rtr. _in-
DATE[Rt3r_t:n 11 -1fj-h�',.. Fran To` Ft._� in. in.
TIME COMPLETED J,Qp AM p "PM r„g— � _ � -
8. SANDIGRAYEL PACK:
].WELL LOCATION: . Depth Sirs Maeria!
Clrr:11 al Dh U COUNTN_C)XeJQ�. F om_�_ToFrllk
'PLLSTP IAni-L n C P r�p„� From To Ft
{BbaaK Nuns.Nwmbwe.Cammwpy;SubdAAaron.Zot.A Pxcet,zip Coda)
TOPOGRAPHIC I LAND SETTING: 38.DRILLING.LOG
WatW>e [3Valey ❑F*' ORidge 00ther -- From To Formation Description
(check appi*aw boa) I h e Q
Wy be in ray
LATITUDE 3 num— mrmrtn,axnncis or
LONGITUDE, inadWidulf3n= 1 - iYSr
(( [atitud'=nangnWe sarucx: OGPS DTapagraphic map
(kcation of wed must be sho"on s UsGS tepo map and
aHBcned to 1h&Avm?nfflusbg GPS)
4-WELL OWNER
OWNER'S WWE�� ,
STREET ADDRESST W
City or Town state 2i(s —Ln
Code
Area code- Phone number
S.WELL DETAILS II. REMARKS:
a. TOTAL DEPTH;3y S
b. DOES WELL REPLACE EXISTMIG WELL? YES p No
d. WATER LEVEL Below Pcy of Cuing: I rX:HEREBY CERT- YTNAT TKS WELL WAS CCtl6 LACMDN ACcoRDANCE W"N
E7 FT- 15A NGAC 2C,WELL CDN6mX71aR STAKIARDS,Aim TRATA 00P OF iHM
(Use°+'0 Above Top d Cuing) RECORD HAS BEEN PROVOED TO THE WEU OWNER, r
d. TOPS C�g IS 1 FT Above Lend.Surface' Q� Q�_ \A'�� �Ane„� (��(��
T d tam61ated aVtu dare land s4riaxe may require S{Gp TURE OF CERTIFIED W ELL CONTRACTOR n-�avwia einactcfdance%vAhi5ANCAC2C.0tt8. _��'"" I�
e. WELD(pm)- 1C) METHOD OF TESTR .—y,�i,;UL1'QC. K I . tl .n� t
PRItdTED NAME OF PERSON CONSTRUCT THE WELLr

RESIDENTIAL mrLL CQrVSTRVC"10N RECORD
' hmth Carclma Department of Ervinnun ,,r and Ngwmr Rmourcxs-Division of Water Qnzk'rtp
WELL CONTI Af-'TOR CERTIFICATION 0
--1.WELL CONTRACTOR: f. DISINFECTION:Type
( 1QVVIHO S l i:�y'G(L1(� s. WATER ZONES wepth).
WapCwrlraclor(indivxLualJ Neme,J� l1 ^^. Frem To FrgT To
Flom To Frmn To _
'Nett Contractor ComparnycM,arne ` J From Tn _____ From.T To
-
STREET ADDRESS.`'n l ,fit\ (� (\. S. CAStNi: Thickgeesst
7 f Datsth Dimrieta Weiot AumnA
From O To_�L�Ft fis."as c .E
Cityat'rown Staf6 Ziy Code From T9,_ Ft.
I
I I.g.?S- , -dQ j From To Ft. 11
Area ca]e- Phase nuyntw
2.WELL INFORMATION: f. GROUT:. Depth ����ppA_iviai riN Methrod
_IX
SITE WELL ID tsfeaPp7iceblal From To .?�hr. Ft r I
STATE WELL PFRMIT#(e appt;cabre) Front To_ Pt
DWQ cr OTHER PERMIT t!(A eppkaie) S. SCREEN:. .. Depth Dim"er Smsize feria
WELL USE(Check Appticab%8oxX Resida ma)Water Suppry W/ FraR To Ft�(II, in : �..
From To FL_im —in.
DATE DRILLED JL_ls`rn 4 Fran _ Tom_ Ft.^ i;a. in..
TIME COMPLETED aloo . . Am o PM rjy
9. SANDIGRAVELPACH:
3.WELL LOCATION: DO^ Size Material
CITY: COUNTfr1 � Fnxn._,To Ft:__
I� From: ,c Ft. 7
s L Ina Cr{_GOYNL�L Front - To FL I{
Nun+twre..CammmMv,subdiidsbn,Lot No..Pamal:zW Codel
TOPOGRAPHIC f LAND SETT04G: DRILLING LOG
C]Slape ❑Valley OFlat ORIdge 00thar From To Formation Description
(check apprupdata box) 0 (0,
CIA
LATITUDE 9
r . `)tN
LONGITUDE_ ME
LafttleAkongdWe strurce: ❑GPS OTopographie map
I tbcaraxr of weBrtw 1 be shown W a USES fopo map and
attaebed to the lhrm Inorusirg Gas)
4.WELL OWNER
OWNER'S NAME� '.� e' -.____
STREET ADDRESS
r
Cirt or Town State ZirCode
Area code- Phone number
R.WELL DETAILS: I. REMARKS:
..p��tp 11�k
V a: TOTAL DEEPTH: CoOSr
i b. DOES WELL REPLACE£XISTfW WELL? YES❑ NO Uy
c. WATER LEVEL Below Too of Cain' I OO HEREBY CERIVYTWIT ME Wru WAS OONSIRUCfD Ai ACCORDANCE WnW
op m9_._�`!FT. iSA NGAC 2C,WEU CIDRSTRUCIYJNSTANOARDS,AND TNATACOPY OF7W
{Use"+"d AI>ovC Tap Tk G85Mg) RFXWO HAS BEEN PROVIDED TO THE W ESL OWNER
d. TOP p CASING IS FT Above Land audace" . C . nrwr
op d Cos tccwdatad atfa betas Land surface may requtre ATURE OF CERTtF£D WELL CONTRACTOR DATE
a variance in Hccoedance vrftll i5A NCAC 2C.Oi 79. _\
0. WELD{gpm)- _MEMOD OF TEST h�a Jume< 9 , U7r! <p(�
PRINTED NAME OF PERSOt+t CONSTRUCTING THE WELL I

OWNER
R SIQ6111 IL Nvri,t,CONS IItticr N RECORD NIVVD
North Catalina Dcpallnlcul ul Envilonmenl and Nalural 1(cmanccs Division of Water Quality NC
TVI(I.I,CON 1'I1IOlt CF10IFICAIION it 1 05-
1.WELL CONTRACTOR: I. DISINFECTION:Typo �7 Arnounl Z �tf
Eb11,F ( C H. WAKR ZONES(depth)
/ r
Well Cmhxiro(lndividuaq Name From _7,y �To �o Fran 70
NILLER WELL DRILLING , INC . nan__w Fran To
Well Conhncla Company Name Flan_ To Flom To__
STREETADDRESS P . O . BOX 567 O. CASING: 10,10nessl
Depth Diameter Weight Idalclial
HAYE_SV1LLE NC 2p9D�______ Ran 0 To9/ rll-IZS- ./�y STccL
City or—Ton'-1 State Zip Code F1on To Ft.
LC E3_--).- f337-2�_97 Flom To 1,1
Area code- Phone number
T. GROUT: Depllt pMaterial MMIod
2.WELL INFORMATION: O To S Ft. Thntid
Fran 1O/'p
SITE WELL ID/1a apekilbr<) Front To Z.0 Fl.
STATE WELL PERMRR0l npvlknble) Fran Tir FI.
DWQ a 0111ER PERI,IIT e(if applirable) 8. SCREEN: Depth Dian allot Skd Size Malmial
From To Ft. In. In.
WELL USE(Check Applicable Boa)' Residmillal Wale,Supply
Ran to FL_hl. _ k1.
DATEDRILLEDlii -or Ran To FL_bl. In. r
TIME COMPLETED 0 AM PMLI
H. SAND/GRAVEL PACIti
3.WELL LOCATION: Depth Size Material
CITY: A1uROhy COUN I L ht!" ////C(.- From To Ft.
Rum To Ft.
lU_Ll�_N 5P�l�. } Ron lo_FI.
ISheel Nis—.. m Zq,Code)
TOPOGRAPHIC I LAND SETTING! 10.(TRILLING LOG
❑SI.pe OVaney FyIA C)Rldge ❑Omer Flom To Formation Desaipl'an
(check oppnoprlale bow)
r Met,IK in drgr«s,
LATITUDE fZ mina
LONGITUDE ry !!+,setmnis ur
D y Ql J Up r Ine Jrcimal fonnAl
_
Lmilude/longitude source: DGPS LITopographic map
fko nikm of Iver musf he shown on a USGS(opo mnp and
attached to this fan,I not using GPS)
B
.WELL OWNER r�n17,�1
OWNER'S NAME 1`, 1Udy
STREET ADDRESS
2890(0 0
City or loom I Stale ZIP(;We
Lcka�8_-_'W37- 311-1
As"code- Phoae number F
u. REnlnut(S:
S.WELL DETAILS: /
a. TOTAL DEPTH: /
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO Q' _
1uo Nrnceycrn]vy nlAl will Writ WAS rr)ns1l/C1FD WACcaWillilDAnrr W ,1
e. WATER LEVEL DeImv Top of Casing. y0 FT. IANCAC]C Wri.I CDNSInVCIrNIeUNDMn4 Rle lIU tAC NyOr llpa
(Use'*'II Alb r e Top of Casing) IIECORo 11A5 BEEN PRyvILIE0 10111E W FLL OWNER.
d. TOP OF CASING IS FT.Above land Sullme'
'Tell of casing laminalal opa below land insibi ll may require R � UA
a variance b xcordancewith 15A NCAC 2C UI I8. IGNATUR'OF CERTIFIED WELL CONTRACIUR UAI E
a. YIELD(gpm):_METHOD OF TEST /g
..+ PRII41EU NAME OF PERSON CONSIRUC181G TIIE WELL.
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., From G'W.1a
1617 !loll Service Center—Raleigh,NC 27699-1617 Phone No.[phone] Bxl 568. Rr, Nu5

V
M SIA11 u
>! OWNER
t t r RESIDENTIAL WEt.L CONS ruucrION RECORD MWD
x
No11h Carolina Department of Environment and Natural Resources-Uivisiml of Water Quality NC
NVELL CONTRAC-1'011.CEIRTIFICATION If--� y0�
1.WELL CONTRACTOR: L DISINFECTION:Type Amount /
g. WATER ZONES(depth):
Well Contractor(Individual)Name Rom &j) To_g 9'.. From To
MILLER WELL DRILLING , INC . From To From—To—
Well Contractor Company Name From To Ron To
STREET ADDRESS P . O . BOX 567 6. CASING: Thick,rossl
� , /Deplh Diameter Weight �edal
HAYESVILLE NC 28904 _ From To R. i
City Or Town Slate Zip Code Fran 1-0 Ff.
t 828 } 837-2997 From Tn rt.
Area cafe- Phone number
T. GROUT: Depth 1�llalerial Method
2.WELL INFORMATION: _� I O
From To FI. ✓�y�T /i2�
Sir E WELL IDR(Bapplicable) From _Tv_3 Fl.
STATE WELL PERMITITof applicable) From To Ft.
DWQ or OTHER PERMIT Irif applicable) E, SCREEN: Depth Diameter Stoll Size Material
From To FL—in. _ In.
WELL USE(Check Applicable Box): Residential Water Supply❑ From To FL—In. _ In.
,
DATE DRILLED From To FI. In. _In.
TIME COMPLETED AM❑ PMU 9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: 6 °/IJ S ,/d/✓ COU NTY C' CI ��P�— From To Ft
From To Ft.
l5ueel Name,Numbers,Community,SubdMsion,Lot No.,parcel,Zip Code)
TOPOGRAPHIC f LAND SETTING, 10.DRILLING LOG
❑Slope Ovalley It7Fal1 DRldge ❑Other From To Formation Description
(check appropriate boa)
r--' r May be in degrees.
LATITUDE 9y& ruinVles,secomiso
LONGITUDE-S3
tf' in a deem al Tomral
.S I '�
Latilude/Iongilude source: OGPS OTopngiaphic map o
(location or"I must be shown on a USGS lopo map and H
attached to this fom17 not using GPS) f V
4.WELL OWNER
OWNER'SNAME ' Cn' �^� C' /p �G C'��
wL
STREET ADDRESS '1-1 q -V _�-
City or Town tale Zip Cafe
Area code- Phone number
11. REMARKS:
S.WELL DETAILS: f
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO Ek�
1 DO I IEREBY CFnTIFY THAT T119 WELL WAS CONSIRUC7F0 N ACCOROAIICF WITH
e. WATER LEVEL Below Top of Casing: 1,9 FT, 15A NCAC3C.WFIA CONS I RUC RON S1ANMRDS,AND INAT A COPY OF Till
(Use'+'If Above Top of Casing) RECORD FM BEEN PRO'VUED 10 THE WELL OWNER.
d. TOP OF CASING IS_�_FT.Above Land Suilace' ro -
'Top Of casing terminated atlor below land surface may require �NATUR OF CERTIFpIED WELL CONTRACTOR4� DArE
a variance In accordance with 15A NCAC 2C.0116.
METHODOFTEST � / 7
re. YIELD(gpmJ:�L, PRINI ED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality wilhln 30 clays. Attn: Information Mgt., Fam Gw-ia
1617 Mall Service Center-Raleigh,NC 27699-1617 Phone No.[phone] exl 56B. Ron.7/05

���AI�•4' OWNER
Y (f R
RIiS/ULN"I'IAL TVEt.L cvlvsruucnuN R :coltu �� - 'Mw0
North Carolina Dcpmmncut of Enviloun ent and Nalurel Itesalrcev.Division oI Water Quality NC
NVELL CONTRAC'f(Iit CERTIFICATION 0 2410 r
1.WELL/CONTRACTOR: 1. DISINFEC110N:Typa Amount
( 0. WATER ZONES(deplh):
-ea Cadracla pndivkhlal)IJan1e From 3Jl To k,�T— From To
MILLER WELL DRILLING , INC . Flan To From is
Well Conti Mint Canpany Name Flan To Flan To
STREETADDRESS P . O . DOX 507 G. CASING: TldcMaessl
Depth vilarnelef Weight Malerial
IIAY_ESVILLE _NC 20904____ a rrn—a�ToLFI.
avn S
City" Ttale Zip Code Fran To Ft. _
From To Ft.
L_E?ZE}_-)- t3 3 7_Z 3 7 —
Atea cafe Phase numbs
7. GROUT: Depth Malerinl Melirtd
Z.WELL INFORMATION: Fran� �jr _B
7o rl.
SITE WELL ID apt applicable) Fran _To-,20_Fl.
STATE WELL PERMITalaapphcable) Ran To rL
DWQ a OTHER PERMIT e(if applicabre) a. SCREEN: Depth Dianeter SM Size Matmid
/ Ftan TO—Ft.—In. _ in.
WELL USE(Checkl Applicable Box) Residential Water Supply ur Flan 10 FL_In. _ In.
DATE DRILLED 1/-)q-0 S` Rom To FI._in. _ In. r
TIMECOMPLETED_J i D O AMU PML4--� g, SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size material
��11 /, Fran To FI.
CITY: ,QNO-rC W f COUNTY 9�/�D/L C'�i From To_FL
Fran To rL
(SNewl Nana,N,enhea,CPn1,\noIll.SobdlM.k ,.Lot No,_1'alcwl,]b,Codw)
TOPOGRAPHIC I LAND SF�T ING- 10.DRILLING LOG
❑Siq» pvaney pbkri ORldge pother From To Formation Desctiplbn
(check Wp,opdala box)
A1ny IV in dcrrers,
LATITUDE nrinuirs;secrnxis or
LONGITUDE 2 V �_ '1�'1 3$ in a Aecmul fennel
UtiUvleflongitodc Souks: ❑GI'S E)TOpogrnphic map '
(krnlbn of wpa musr he shown an n USGS(opo map and [7
attached to this ham li not using GPS)
4.WELL OWNER O
n I r L � tV
OWNER'S NAME I� fa V P cm)
STREET ADDRESS Pb F,OX 1032,
ATXidaa. -S nlr,
Cilya IOwn Slate Zip Cafe
At"cafe• Phone numbs
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH: 1/o s
b. DOES WELL REPLACE EXISTING WELL? YESp
1 DOI IFnEIIY CFnrGY mlAI Iraq WEII WAS CO PIRJOTO aI ACCO00"IrF WI In
a. WATER LEVEL Del"Top of Caslnq.__�FT. ISA nCACZC.WELL CONSImICIM SIAIIMRnS.ArID➢1A1 A COPY OF 11aS
(Use'#'NAlwe Top dCasing) RECOROPS BEENPR1TVIOE0toRIE WELL OWNER.
d. TOP OF CASING IS� FT.Above Land Surface' Ptu -
'Top of ca%ing terminated at/or below land surface nosy require SIGNATURE OF CERTIFIED WELL CONTRACTOR VAI E
a vaiance in eccadancewilh ISA NCAC 2C.0118. ^ )jo
a. YIELD(gpm): 3 mETROD OF TEST e P C
# PRINI ED NAME OF PERSON CONSTRUCTING 111E WELL
,
Submll the ollylnal to the DIVISIan of Walor Quality Within 30 days. Atln: In(onnallon Mgt., ramrw-ia
1617 tdall Servlce Cenler-Raleigh,NC 27699-1617 Phone No.[phone] axl 568.

ci
s - OWNER
RaIDENTIAL WCLLCONS'I'RUC'I'ION RECORD MWD
North Carolina Department of Environment and Natural Resources-Division or Water Quality N ✓','•
�1 C
WELL CON'FRACTOIt CERTIFICATION N 69
1.WELL CONTRACTOR: f. DISINFECTION:Type /�r�> Amount _
V /J/'e �?ee'CC- g. WATER ZONES(depth):
Wen Conlractor(Individual)Name From To From To
MILLER WELL ORILLING , INC . From To From To
Well Contractor Company Name From To From To '
STREETADDRESSP•O. 80X 567 S. CASING: Thickness)
Depth Diameter Weight alerial
HAYESVILLE , N . C . 28904 From To `f fl30iC l 8 !/�
City or Town Slate Zip Code Fan To Ft.
( 828 )- 837-29 77 Flan To Ft.
Area code- Phone number
2.WELL INFORMATION:
7. GROUT: Depth Material Method
0 To 3 FI.��CR Fran
SREWELL IDaprannncame) From' To2O' Ft.
STATE WELL PERMITO(il applicable) From To Fl.
DWQ or OTHER PERMIT#(if applicable) __ 9. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply I, / Fran To FI._In. In.
r Fran To Fl._In. _ In.
DATEDRILLED > Fran To Ft.—In. _ in.
TIME COMPLETED AMC) PM Q_� g. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
From To Ft.
CITY: &4�j ' r— COUNTY , C' Pc- Fran To Ft.
1—ao. 'T Fc,,li Fran To FL
15br t Name.Number,Cammunily.Subdr0sion,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/ NO ETTING: 10.DRILLING LOG
oslope ovaney 1 pRldge ❑Other From To Formation Description
(check arpropriale box)
LATITUDE ,� 2. O May be In Cothi ;
❑Illlrlltl•SfC1111J5 a '
LONGITUDE f y, �Q'f r in a Decimal!Donal
Latitude/longitude source: c)Gl'S OTopographic neap
(locafion of welf most be shown on a USGS(opo map and
attached to this!am 7 not uskrg GPS)
4.WELL OWNER
k
OWNER'S NAME Tovk., /j/,'c
STREET ADDRESS ��i$ !rwr BC¢a/t'7 Qi' (I+II(rP/. CD
City a Tow 0 Slate Zip Coda
c 82.4 }_(eclq -,3 3o 6
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH:_
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I ODHEREBY CERTIGYIMAT THISWELLWAS CONSTRUCnEDN eCCOROANCE WRIT !
e. WATER LEVEL BeIowTapd Casing: ? FT. 1SIk NCAC TC.WELL CONSmUCT10N STaNDMOS.AND THAT A COPY OF Tres
(Use'+*8 Above Top of Casing) RECORD S BEEN PROVIDED TO THE WELL OWNER.
d. TOP p CASING IS FT.Above Land Surface*
�'�R'_ �� —QS 1.
*Top d casing terminal aVa below land surface may require SI NATUR OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance with ISA NQAC 2C.0118.
e. YIELD(gpm): 0 METHOD OF TEST I" C_(j 4 e e,-(f
PRINTE�F PERSON CONSTRUCTING IHE WELL
SuhlTlit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., ramGW 1a
1617 f,Tiil sr v1E c Ccntor-Raleigh,NC 27699.161T Phone No.[phone] ext 568. Rev.Tfus

OWNER
° 1`! RESIDENTIAL WELL CONSTRUCTION RECORD MWD
North Carolina Department of Environment and Natural Resources-Division or Water Quality +
Nc
WELL CONTRACTOR CERTIFICATION N �C�D
1.WELL CONTRACTOR: I. DISINFECTION:Type Amount
/ Z
_I 21*/,'!/ /� e(f Chi g. WATER ZONES(depth):
VV eB Contractor(Individual)Nana From- 7D To `6.S, From To
MILLER WELL DRILLING , INC . Fran69f _To 25�0.0_ From To
Well Contractor Company Name From To From To
STREET ADDRESS P.0. BOX 5137 S. CASING: Thickness/
Depth Diameter Weight Material
NAYESVILLE , N . C . 28904 Fran C T6_" Ft4/2I jr,2g,0L e af
City at Town State Zip Code Han To FL
( 828 p 837-2997 FIaR To FL
Area code- Phone numbs
7, GROUT: Depth Material Method
2.WELLINFORMATION: From V To ✓� %/Z
SITE WELL ID#(ilapplicable) From�Tog.OFt. e^ 1w C
STATE WELL PERMIT#(#applicable) Fran To FL
DWQor OTHER PERMIT#(9applicable) S. SCREEN: Depth Diameter Slot Size Malerlal
From To FL_In. _ In. -
WELL USE(Check Applicable Box): Residential Water Supply Q From To FLin. _ in.
DATE DRILLED Fran To FIL n. _in.
TIMECOMPLETED Ii D AM[] PMJ2--'
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
yvc�/CLl/S couNrr_C{�CRo�'PL Fran To Ft.
CITY: From To Ft.
Fran To FL
(Street Noma,Numbers.Comnumty,Subdivision,Lot No..Parcel,Zip Code) -
TOPOGRAPHIC T LETTING: 10.DRILLING LOG
Cl slope t,7Valley I ORidge ❑Omer From To Formation Description;- d
(check appropriate box) ,
r May be in degrees. -'
LATITUDE S 13 ' 1 minutes,seconds or
LONGITUDE 78� in o decimal forms(
latitudellongitude source: t]OPS pTopographic map o
(location or way must be shown on a USGS logo map and 'c
attached to(his Arm#rot using GPS) W
4.WELL OWNER
OWNER'SNAME ��]!I%P /.'/ l✓Vw-""`�'� ,3+
STREET ADDRESS 5J7 1, B a0 A^c-(J
City or Town State Zip Code
( F
Area code- Phonenumber
11. REh1ARKSc
e.WELL DETAILS:
a TOTAL DEPTH:
6. DOES WELL REPLACE EXISTING WELL? YES O NO
I DO HEREBY CERMY TNAT TM WELL WAS CONSTRUCIFO N ACCORDANCE WITH r
e. WAY ER LEVEL Below Top of Casing: J�ftlea FT. 'ISA NCAC aC.WELL CONSTRUCTION STANDARDS.AND Twit A COPY OF THIS
(Use-S-B Above Top O/Casing) RECORD RAS BEEN PROVIDED TO THE WELL OWNER. I.
d. TOP OF CASING IS FT.Above Land Surface*
of
'Top casing led Svor below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e variance in accordance with 15A NQAC 2C.011188.
a. YIELDigpm):�,L_METHODOFTEST_ [� �f9i !,P �Z e c�« ;, . J.
PR NTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt,
Form
1617 Mail Service Center-Ralelgh,NC 27699.1 Rev,110A5617 Phone No,[phone] ext 568. -

$A1A u
._;OWNER
RcSlDLilVT1AL \ytiLL CONSTRUCTION REcouu N1W0
` ✓North Carolina Uepartmad of Environment and Natural Resources-Division of Water Quality NC
WELL CONTRACTOR CERTIFICATION N,�
1.WELLZ
CONTRACTOR: I. DISINFECTION:Type Amount
,{I/�/
l y n y ik a-e- g. WATER ZONES(depth): �
Wee Con rrector(Individual)Name From Z,9 To ZZJ From To
-
MILLER WELL DRILLING , INC . From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P . O. BOX 567 6, CASING: Thickness/
Depth Diameter Wei hl Material
NAYESVILLE NC 28904 F'°In__�__Tv, ,�F[ /,/Zf f� (Eu� VUL
City or Town State Zip Code Fran To Ft. ✓L n r"
From To Ft.
837-2997
Area code- Phone number 7, GROUT: Depth atellal Method
2.WELL INFORMATION: From V To �3 FI.� /2
SITE WELL ID Ahl applicable) From=To=FI. t Ni /
STATE WELL PERMITA(eappecable) Ftom To Ft.
DW Q or OTHER PERMIT A(II applicable) 8. SCREEN: Depth Diameter Still Size Material
From To FL_In. ,_ in.
WELL USE(Check Applicable Box): Residential Water Supply p From To Ft. in. _ In.
DATE DRILLED a-j 7 _ / From To FL in. _ in.
TIME COMPLETED1i L2 AM❑ PM(yam 9. SANDIGRAVEL PACK:
J.WELL LOCATION: Depth Size Material
Fran To FI.
CITY: COUNTY Cyr Fran To FL
From To Ft
(Street Nark,Number,Carnmu 114.SUbdldaWn,Lot No.,Parcel,2p Code)
TOPOGRAPHIC I LAND"TTING: 10.DRILLING LOG
❑Slope pvaley WFlal ❑Ridge OOther From To Formation Description
(check appropriate box)
y� 92257 May be in degrees,
LATITVDE ' '1y n3,99s minUlr,seconds or
�✓J e in a decimal formal
LONGITUDE L V• & -
Latitude/longitude source: ❑GPS CiTopographic ntap
(bcafbn of wet must be shown on a USGS logo map and `r*1
attached to this form 7 not using GPS)
1.WELL OWNER � � -
OWNER'S NAME �1G�lniH�
Ln
STREET ADDRESS [11IArc61 9A
IVC r� =
M�rd�Hp_ Vc .z8R a
City o/To(Wr Stale Zip Coda
Area code- Phonenumber 11. REMARKS:
5.WELL DETAILS: S �� /
B
a. TOTAL DEPTH: - /
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
/ IOo NERE9YcFATIF YmAj THIS WELL WAS CONS1RUCIEDNACCORDANCE WNN
e. WATER LEVEL Below Top of Casing: FT. I5ANCAC2C,WELL CONSTRUCTION SIANOARDS,ANOTHAT A COPt OF Pelt
(Use'*"0 Above Top ofCasing) RECalO 6 EENPROVIDEDTO THE WELL OWNER,
d. TOP OF CASING 1S_ - FT.Above Land Surface
*Top of casing terminated aUor below land surface may requlre SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a valance In accordance with 15A NCAC 2C.0118, n ,QCCCC/
e. YIELD(gpm):�[ METHODOFTEST�//� ��1 DN /`
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:lnformallon MgL, Form GW-1a
1617 Mail Service Center-Raleigh,NC 27699.16117 Phone No.[phone] exl 568.' Rev.7/05

..SIM[o I II�L JV
,.--.., •4. VIA OWNER
RESIDENTIAL wEt,L CONSTRUCTION RF,CO1tU rypyp
N orth Carolina Department of Environment and Natural Resuurccs-Division of Water Quality NC
\\'ELI,CONTRACTOR CI'slt"f IFICATIONN
1.WELL CONTRACTOR: I. DISINFECTION:Type—&= Amount 2
?6I&V a"-Co- 0. WATER (depth):
Well Cmh to vid(Indival)Name From , To T From To
MILLER WELL DRILLING , INC . From To From To
Well Cmtlaclo Company Name From To_ Flom To
STREETADDRESS P . O. BOX 567 S. CASING: Thlcknessl
Depth Diameter Wei hl Material
HAYESVILLE NC 28904 From / To- -- L ✓ZJ /P9Y /�lic
City a Town State Zip Code Fran To Ft_.
( 828 Y 837-2997 From To FL
Area code- Phore numbs
7. GROUT: Depth •� Material Method
2.WELL INFORMATION: From 0 To .3 Ft. OR7/fA-d /9/;.? _
S ITE WELL ID Rill applicable) Fram= fa
STATE WELL PERMITR(e applicable) From To Ft.
D W Q or OTHER PERMIT R(If applicable) S. SCREEN: Depth Diameter Slot Size Material
From To FL_In. _ in.
WELL USE(Check Appticable Box): Res)denliai Waler Supply O From To Ft.—In. _ In.
DATE DRILLED 1O :LDS— 0S Flom Tc Ft._In. _ In.
TIME COMPLETED ZO i OD AMR PM❑ 9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
�yT From To FL
CITY: /r/URP�% COUNTY e-4 e/Pp ACL Flom To FL
From To FL
(Sbeel Hama.Numbers.Community.Subdivision,Lot No..Pe,cel,Zip Code)
TOPOGRAPHIC!(AND SETTING: 10.DRILLING LOG -
ps%Gpe Overlay OFlat ORidge ❑Other From To Formation Description
(chedl sppropriab box)
Maybe in degree,LATITUDE
-
LATITUDE � � ' mi L7
nus:woods in -
O 6 , in•dttmlal fiemal Ti
LONGITUDE n
Latitude/longitude source: PS ❑Topographic map v
(location of"I must be shown on a USGS loop,map and -
altached to this form Riot ustig GPS) O
4.WELL OWNER .�
OWNER'S NAME / rL ,
STREET ADDRESS i M Ff�✓J r.
City or too State Zip Code
Areacoda• Phmenumber IL REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH: /
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO a
l I DD HEREBY CFmFY THAT 7111E WELL WAS CONSTRUCTED IN ACCORDANCE"IN
e. WATER LEVEL Below Top of Casing: T. 1SA NCAC 2C.WELL CONS TRUCnr1N STANDARDS.AND THAT ACDPY OF 1111S
(Use'*'0 Above Top o1 Casing) RECORD I S BEEN PROVIDED TOTHE WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface' IQ
'Top of casing terminated allm below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a valance In accordance with i 5A NCAC 2C.0118.
i-F--METHOD OF TEST y's. YIELD(gpm): P-iI
NTED PTAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attl1: Information Mgt., Fam GW-ter
1617 Mall Service Center—Raleigh,NC 27699.1617 Phone No.[phone] ext 666. Rev.U05

I
rMsr /; a OWNER
RESIDENTIAL \VELL CONS'I7tUC't'ION RECORD Myrp
North Carolina Department of Environment and Natural Resources•Division of Water Quality NC VI
WELL CONTRACTOR CERTIFICATION
1.WELL CONTRACTOR: 1, DISINFECTION:Type AAmount
P /),;q ke ct-e- g. WATER ZONES(depth): /
Well Contractor(IndWiduaq Name From Z e To Z ZS From To
MILLER WELL DRILLING , INC . rran TD From To
Weil Contractor Canpany Harm From To Fran To
STREETADDRESS P . O . BOX 567 6. CASING: Thickness/
Depth / glameler Wei hl Ienai
HAYESVILLE NC 28904 Frurn—L— �_Ft. 6./Zf •/�9 f{G
City a Town State Zip Code From To Ft
t B28 } 837-2997 rran To Fl.
Area code Phone number
T. GROUT: Depth Material Method
2.WELL INFORMATION: Ft.3PORTI -d H/R
Fran O To
SITE WELL ID A(If applicable) Fran .3 Tom FI. e/V om/ C- H,R ,
STATE WELL PERMITHpr applicable) Fran To Fl.
DWO or OTHER PERMIT H(If applicable) 8. SCREEN: Depth Dlameler Skit Size Material
Fran To FL_In. _ in.
WELL USE(Check Applicable Box): Residential Water Supply(IF,D10 To FI._in. _ in.
DATE DRILLED �y ��� —�� Fran To Ft_In. _ In.
TIME COMPLETED AM PM❑ 9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
,n From To Ft.
CITY: /t•rURa�y COUNTY PQa Pei From To Ft '
Fan 7o Ft
(Si ee1 Name,Numbers.Community.Subdm.wn,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
(3Sktpe OValey ❑Flat ClRldge ❑Other From To Formation Description
(ehea appropilale box)) �.� Maybe in degreo,
Oaf
LATITUDE -- i7 . lw minor",seaexls or -
�I6L / in a decimal rornul _
LONGITUDE V T
Latiludellongitude source: ❑GI'S oTopographic map
(Ax fion or Wea must be shown on a USGS fopo mop and
attached to this ram(not using GPS)
4.WELL OWNER / CD
OWNER'SNAME Y/ GY ZIC1'K1V1 6 v7 a
STREET ADDRESS I S6 Fi'r nY�Sh O C I�u�Y.. I�(�
City or Tbv1 Stale Zip Cafe
Area code- Phonenumber 11. REMARKS:
S.W ELL DETAILS: /
a. TOTAL DEPTH: f9/OJ
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
/ I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WON
e. WATER LEVEL Below Top d Casing: SD FT. ISA NCAC 2C,WELL CONSTRUCTDN STANDARDS.AND THAT A COPY OF THIS
(Use'+'a Above Top d Casing) AEC ORD HAS BEEN PROVIDED TO THE WELL OWNER
d. TOP OF CASING IS FT.Above Land Surface' �� /O/0—Oj'
'Top d casing laminated aUor below land surface may require SIGNATU E OF CERTIFIED WELL CONTRACTOR DATE
a variance In accordance wilh 1 SA NCAC 2C.0118. D
e. YIELD(gpm): / _METHOD OFTEST
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information MOL, Form GWfa
1617 Mail Service Center-Raleigh,NC 27699.1617 Phone No.[phone]• It 560. Rev.7105

,
OWNER
1;
RESIDENTIAL WELL CONSTRUCTION RECORD -r MWD
. � North Carolina Department of Environment and Natural Resources-Division of Water Qualify NC
.y u.,.....:
WELL CONTRACTOR CERTIFICATION N 2 L/9.S-
1.WELL CONTRACTOR: I. DISINFECTION:Type Amount <f
Phr/� R if If U. WATER ZONES(depth):
Well Contractor(individual)Name From /u2s To /yS' From To
MILLER WELL DRILLING , INC . Fran To From To
Well Contractor Company Name From To From To
STREET ADDRESS P . O . BOX 567 6. CASING: Thicknessr
Depth Diameter Weight Material
HAYESVILLE NC 28904 Front-L—T°-�S FL /=/`i '/gam
City or Town State Zip Code From To Ft.
f y 837-2927 From To—Fl.
Area code- Phone number -
7. GROUT: Depth Material Method
2.WELL INFORMATION: Fran O To,P I? Ft. '0 T //Q
SITE WELL ID#(it applicable) From To Fl.
STATE WELL PERMIT#(a applicablel From To Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diarneter Slot Size Material
From To FL-in. _ In.
WELL USE(Check ApplicableBox): Residential Water Supply O From To FL_In. _ in.
DATE DRILLED / -`7ic 0-0� From To Ft._In. _in.
TIME COMPLETED •Q AM p PM e, SANDIGRAVEL PACK:
3.WELL LOCATION: Fran To FI.Depth Size Material
( p
CITY: pC r�C 11 //te COUNTY C/'U AL` Ftom To FL
From To Ft.
(Sheet Name,Numbers.Community.Subdivision,Lot No.,Parcel,Zip Code) -
TOPOGRAPHIC:I LAND SETTING: 10.DRILLING LOG
V6"/ OValley []Flat ORidge OOlher From To Formation Description
(check appropriate bar)
May be in degrees,
LATITUDE J_ n'7•�y9 minutes,seconds or -
LONGITUDE,�� • Zj�j ins decimal format
Latitudellongitude source: ❑GPS ❑Topographic map
(location or we#must be shown on a USGS topo map and
attached to this form#not using GPS)
r a-1
4.WELL OWNER '-)
OWNER'S NAME PC fe f�02
pp '4—
STREETADDRESS 90 UDOL Z�7-7
1+1r, spa-dA/a--5 , C-L� 320ss
C or Town Stale Zip Code
Area code- Phone number
11. REMARKS:
5.WELL DETAILS-
a. TOTAL DEP7H:�� - /
la. DOES WELL REPLACE EXISTING WELL? YES❑ NO Ly
7 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH
e. WATER LEVEL Below Top of Casing: T FT. 15A NCAC 2C.WELL CONSTRUCTION STANDARDS.AND THATACOPY Or THIS
(Use-+•8 Above Top of Casing) RECORD HAS BEEN PROWOED TO THE WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface'
-Top of casing terminated allor below land surface may require F CERTIFIED WELL CONTRACTOR DATE
a variance In accordance With 15A NCAC 2C.0118. SIGNATURE p
e. YIELD(gpm):�METHOD OF TEST I�rR_ L /1 ec��i
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information li Form GW-la
1617 Mali Service Center-Raleigh,NC 27699.1617 Phone No.[phone] ext 566. Rev.7105

i
- .,. aA1Fo
,�Tyf a OWNER
R RESIDENTIAL WELL CONSTRUCTION RECORD MWD
4 North Carolina Department of Environment and Natural Resources-Division of Water Quality NC ✓
WELL CONTRACTOR CERTIFICATION H -y
1.WELL CONTRACTOR: I. DISINFECTION:Type Amount
U/ J(` e e e c� g. WATER ZONES(depth):
Well Contractor(Individual)Name From To. iw From To
MILLER WELL DRILLING , INC. F:om w To y70 From To
Well Contractor Company Name Fran To From To
STREET ADDRESS P . O . BOX 567 6. CASING: Thickness/
Depth Diamele Wei bit Material
HAYESVILLE , N . C . 28904 From�ToZD2 Ft. l,1T UC
City or Town Slate Zip Code From To Ft.
Bt 28 )- 837-2997 From To Fl.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From_o To 3 Ft. 047-117� /7i/�
SITE WELL ID#(ir applicable) From' To.�Q' Ft. 9r'yfCM>
STATE WELL PERMIT#(il applicable) From To Fl.
DWQ«OTHER PERMIT#(it applicable) 8. SCREEN: Depth Diameter Start Size Material
WELL USE(Check Applicable Box): Residential Water Supply 0 Fran To Ft. In. _ in.
C, From To FL—in. _ in.
DATE DRILLED 7 �oL� -�� From To Ft.—In. _ in.
TIME COMPLETED 3 30 AM p PM®—' g. SANDIGRAVEL PACK:
3.WELL LOCATION: /' Depth Size Material
CITY: //l D Ie COUNTY CACXbX'C From To Ft.
,� From To Ft.
( "e US�C LT Rol r From Tc Ft.
(Street Name,Numbers,Commundy.Subdivision.Lot No.,Parcel,Zip Code)
TOPQ�RAPHIC I LAND SETTING: 10.DRILLING LOG
.i
[]Valley ❑Flat ORidge []Other From To Formation Description
(check appropriate box)
S rD t 6 r May m e in degree,
LATITUDE mincs,seconds or
LONGITUDE , ,�� .9,5 in a decimal formal
Latitude/longitude source: ❑GPS ❑Topographic map
(location of we#must be shown on a USGS lopo map and c i
attached to this form#not using GPS)
I.WELL OWNER
OWNER'S NAME Pl?l /IQ'7t/>lf
STREET ADDRESS It o '
Mar', etfbt (,-A 30oCl
City or Town State Zip Code -
Area code- Phone number
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH:
la. DOES WELL REPLACE EXISTING WELL? YES❑ NO
/ I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
e. WATER LEVEL Belau Top of Casing: T. 15A NCAC 3C.WELL CONSTRUCTON STANDARDS,AND THAT COPY OF THIS
(Use'+'if Above Top of Casing) RECORD HAS BEEN PRWIDEDTOTHE WELL OWNER.
i
d. TOP OF CASING IS FT.Above Land Surface'
*Top of casing terminated aVor below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. p
a. YIELD(gpm):�Z METHOD OFTEST 6 �K xeecc-
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., F«m cw•ta
1617 Mail Service Center-Raleigh,NC 27699.1617 Phone No.[phone] ext 568. Rev.7105

SIATg
OWNER
7 T=t RESIDENTIAL WELL CONSTRUCTION RECORD _r MwD
North Carolina Department of Environment and Natural Resourccs-Division of Water Quality ✓
+ � NC
WELL CONTRACTOR CERTIFICATION A yO f
1.WELL CONTRACTOR: I. DISINFECTION:Type 7`t Amount Z �(a
g. WATER ZONES(depth):
Well Contractor(individual)Name From To 78s, From To
MILLER IdELL DRILLING INC . I'murn3 5 / To -3YO' From To
Well Contractor Company Name From To From To
STREET ADDRESS P . O . BOX 567 6. CASING: Thickness/
®/Depth
o_3j- lo,45' Weight Material
HAYESVILLE , NC 28904 From To FL L S�ei (/C
City m Town State Zip Code From x y, To 1/O FL .ZS ITCCI
8( 28 y 837-2997 From To F1.
Area code Phone number
7. GROUT: Depth Material ¢Method
2.WELL INFORMATION: From__o To 3 Ft. /eTIA r/rjP
SITE WELL ID Apf applicable) From 3� To1�Or FI. P dNr Hr2
STATE WELL PERMIT#(eappllcable) From To Ft.
DWQ or OTHER PERMIT#(it applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply g__� Frorn To Ft. In. _ in.
p From To FL_in. _ in.
DATE DRILLED J ", �-�S From To Ft.—In. _ in.
TIMECOMPLETED .3:I5 AM[I PM®--' 9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: UI O /C T COUNTY Cke011'-c- From To Ft.
From To FI.
From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
®5b []Valley ❑Flat ❑Ridge ❑Other From To Formation.Description
(check appropriate box) '
r May be in degrees,
LATITUDE 3 _ 10. 16(/ minutes,seconds or
LONGITUDE e) Lit )3. -/S� y in a decimal Forms)
Latilude/longitude source: ❑GPS ❑Topographic map o
(location of welt must be shown on a USGS topo map and i...�
attached to this torn!not using GPS)
N
I.WELL OWNER
OWNER'SNAME J'/&1/ �Gr/?H7S/G1TPl1✓d q -
STREETADDRESS 2.'100 Oe)k KA 54-e 3(Ly
Mcariefl`a GA 30067
City or Town Stale Zip Code
(Area code- Phone number
II. REMARKS:
S.WELL DETAILS: ['
a. TOTAL DEPTH:
l . DOES WELL REPLACE EXISTING WELL? YES❑ NOD/
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
c. WATER LEVEL Belau Top of Casing. 130 T. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS.AND THAT COPY OF THIS
(Use'+-if Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
i
d. TOP OF CASING IS / FT.Above Land Surface-
, 'Top of casing terminated a0or belay land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance With 15A NCAC 2C.0118.
e. YIELD(gpm): ;� 0 _METHOD OF TEST /i/!L AhI le X CC Cc�
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Fam Gw-1a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

OWNER
din f r
s RESIDENTIAL wct,L corvsruucTL N Ltecottu MWD
North Carolina Department of Environment and Natural Resources.Division of Water Quality NC
�p wA
\VF,LL CONTRACTOR CERTIFICATION q _ 2-3
1.WEL CONTRACTO I. DISINFECTION:Type *'H Amount
/ 1e6 g. WATER ZONES Idepth):
Well Co racla(Individual)Nane Frcm-1yo-To lk- From To
MILLER WELL DRILLING , INC . Flan To From To
Well Conitactw company Name Fran To From To
STREET ADDRESS P . O . BOX 567 6. CASING: Thickness/
Dept, Diameter
a l0 Weight S11 Malerial
HAYESVILLE NC 28904 FrtxnO To Ft. � N
116
City or Town Stale Zip Cale From To FL _
( 828 )- 837-2997 Fran To_FL _
Area code- Phone number T. GROUT: Depth Material Method
2.WELL INFORMATION: Fran_(>To­�26) Ft.
SITE WELL ID e(1I appncabk) From To__�_Ft.
STATE WELL PERMITa(a applicable) Fran To FI.
DWQ or OTHER PERMIT R(if applicable) a. SCREEN: Depth Diameter Sid Size Maleriai
Fran To_Ft._In. _ In.
WELL USE(Check Applicable Box): Residenllal W aler Supply' rrorn To_Ff._in. __ In.
DATE DRILLED az o S Fran To_Fl._In. _ M.
TIME COMPLETED 2 jj:�,7 AM PM,M S, SANDIGRAVEL PACK:
S.WELL LOCATION: Depth Size Material
I� From To Fl.
CITY: COUNTY 4 rHm To Ft. "
Frill To FI.
(Streel Name,Numbers.Caromnily,Subdmslon,Lot No.,Parcel.Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
❑Sbpe (check
❑Flat box) ❑OOmer From To Form Description
(check eppmpiata boa) 0 - 2-0
May he in dep'tts, 2O_ �, 0
LATITUDE -I.. ,T- 02.01A mint",smandsor ,7 Z
in a decimal font
LONGITUDE_A 4 07. 401
Latitude/longitude source: )4GPS OTopographic map
(Iocahen of 118r must be shown on a USGS lopo map and t�
r t
attached to this form 1 not using GPSJ =� m
1V
4.WELL OWNER
OWNER'S NAME .h r -
/ O
STREET ADDRESS ?00 — -
Cityrornal State Zip Code -
zio 04- a 2=!!e
Area code- Phonenumber 11. REMARKS:
S.WELLDETAILS: -7
a. TOTAL DEPTH: ! 2
Is. DOES WELL REPLACE EXISTING WELL? YES❑ NO pf
q 100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED INACCORDANCE WITH
e. WAT ER LEVEL Beim Top of Casing- FT. ISANCACIC.WELLCONSTRUCTgN STANDARDS.ANDTHATACOPYOF➢ 5
(Uli If Above Top of Calling) RECORD BEEN PR TO F OWNER.
d. TOP OF CASING IS�_FT.Above Lend Surface-
. 'Top of casing terminated allor below land surface may require SIG A OF CE lFiEO WELL CONTRACTOR/
a variance MI accordance with 15A NCAC 2C.0116. �O 5 � �
a. YIELD(gpm): METHOD OF TEST I r _ pR NTED NAME OF PERSO CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information MOL, Form GW-Ie
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ellt 568. Rev.7105

e,.snir o�
OWNER
f ~ !:
RESIDENTIAL NVELLCONSTRUCTION RrCORD MWO
North Carolina Department of Environment mTJ Natural Resources.Division DF Water Qualify
NC
WELL CONTRACTOR CI'AVVIFICAT'ION If
1.WELL CpyNT TOR: n ,�� I I. DISINFECTION:Type L'� Amount
',( „ ii 'V U `�[, g. WATER ZONES(depth):
W ell Conliacla(Individual)Name From_To 5iK Fran To
m
MILLER WELL DRILLING , INC . Fran To Fro To
Well Connector Company Name Fran To From To
STREET ADDRESS P . O . BOX 567 G. CASING: Thickness/
Dept l DiDiamfyer Weight Material i
HAYESVILLE NC 28904 Rom_Fra Ft,�
ToFt.-
City a Town Slake Zip Cale
L828 } 837-P997 Fran To_Ft.
Area code- Phone number
7. GROUT: Depth M lariat elhod
2.WELL INFORMATION: From�_Tq�( Ft. e- CaU
SITE WELL ID II(ir applicable) From_To 3 FI.
STATE WELL PERMITS(II applicable) From To Ft.
DWQ a OTHER PERMIT R(if applicable) 8. SCREEN: Depth Diameter Sid Size Material
/ From To Ft._In. _ In.
WELL USE(Check Appii IS B 4 Residential Water Supply Ur From To_Fl. In. _ In.
To_Ft.
DATE DRILLED 10 )L/ 05 Fran
TIME COMPLETED Ll AMC] PMAY g, SANDIGRAVEL PACK:
S.WELL LOCATI/�O��N��: // /�� Depth Size Material
CITY: oyoa.4 w y l le_ COUNTY_(�4440k"- Fr°rn To_Ft.
To_Fl.
Fran To__,Fl.
(Sbeel Name.Number.Commurdly.SvbdlNalpn,Ld Na..Parcel,Zip Code)
TOPOGRAPHIC I LAND SETTING: to.DRILLING LOG
j{slope OVaBey ORA ❑Ridge ❑Ogler From /�To Formation[�escriptbn
ck(che appropriate boa) _r). )y<' 6_l'Ae%/
Maybe int*Asdegrees. CS 7?(CI✓i r !�
LATITUDE _)-.� May
be in cads a a
in a decimal formal
LONGITUDE 3 _LPL_
Lalilude/Iongitude source: OGPS OTopographic map
(location of wet must be stwwn on a USGS lopo map and O -
attached to(his form(not using GPS) .
a.WELL OWNERCD
� y
OWNER'SNAME 'J
O
STRE'E,T �L17
ADDRESS
n c.fl
City a Torn Stale Zip Code
(o1>�79 -`Xo21
Area code• Phonenumber If. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO1)5-
100 HEREBY CER RFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIM
e. WATER LEVEL Below Top of Casing: FT. ISA NCAC 2C.WFLL CONSTOUCIM STANDARDS.AND THAT ACOPY OF THIS
(Use'+'9 Above Top of Casing) RECORD RAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS ) FF.Above Lana Surface'
'Top of Casing terminated atlor below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e variance 4L xc dance with 15A NCAC 2C.Ot 18.
It. YIELD(gpm): 7� METHOD OF TEST (IZ' PRINTED NAME N CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Infonnadon IVIgL, Fam calla
1617 Mall Service Center-Raleigh,NC 27699.1617 Phone No.[phone] awl 566,' Rev.7/05

N SIAI[�e
OWNER
{If{ RESIDENTIAL WELL CONSTRUCTION RECORD MWD
xi l( North Carolina Department of Environment mid Natural Resources-Division of Water Quality NC
WELL CONTRACTOR CERTIFICATION N
1.WELL CONTRACTOR: f. DISINFECTION:Type Amount Z i
��� /CeOC C, 9. WATER ZONES(depth):
�C 1 actor(IndividL)Name Rom 1w- To tff From To
MILLER WELL DRILLING , INC . From340 To 360 From To
Well Conlraclw Company Name Fian To From-To-
STREET ADDRESS P . O . BOX 567 6. CASING: Thickness/
Depth/Z'f Diameter Weight M erial
HAYESVILLE NC 28904 Fmm © To 6 FLA.. zs' /OAZ UG
City or Town Slate Zip Code FT= To FL _
t 82B y 837-2997 From To FI. _
Alea code- Phone number
7. GROUT: Depth jIllatedal Method
2,WELL INFORMATION: From (9 To 3Ft. ORTI/iA4 19iR
SITE WELL ID#(R applicable) Ftom=ToAa!L_FL a
STATE WELL PERMITN(R applicable) Fran To FI.
DWO or OTHER PERMIT 0(il applicable) B. SCREEN: Depth Diameter Sid Size Malmial
WELL USE(Check Applicable Box): Residential Water Supply O From To FL_in. _ in.
From To FI. In. _In.
DATE DRILLED10 :2 y{-O� Rom _To FL_In. _ In.
i TIME COMPLETED O AM[I PM lD-/ 9. SANDIGRAVEL PACK:
3.WELLL(7OCATION: Depth Size Material
CITY:J?X SS / Ow/✓ COUNTY C e1?01V C:� From To FI.
- From To_Fl.
From To_FL
ist,"i Nama.Number.Communily.Subdivision.Lot No.,Parcel.Zip Code)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
0815pe pvaeey OFlal ❑Ridge OOlher From To Formation Description
(check appropriate box)
May be in degrees.
LATITUDE vL��_5 minutes,secondsor
LONGITUDE Sr?. (PSI! I in a decimal formal n
i
L.tilude)iongilude source: ❑GPS OTopographic map
(location of ova!must be shown on a USGS topo map and CD
attached to this form 1 not using GPS) _
4.WELL OWNER L111 '
OWNER'S NAME . C'O
STREET ADDRESS , 97 L^R 1 d.F eta0 X
61ca55 tow All, 28902
City or Town Slate Zip Code
Area code- Phone number.
Il. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH: 3 7o
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO @_
I OO HEREBY CF.RMY THAT THIS WELL WAS CONSTRUCTFD IN WIT"
c. WATER LEVEL Below Top of Casing:_ 60 FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT ACOPY OF THIS
(Use-+-O Abwe Top at Casing) RECO/RO HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS F?.AboveEC
Land Surface* /f Ki 10 �
'Top of casing terminated ablor below land sudece may require YSIGGNNAT E OF CERTIFIED WELL CONTRACTOR DATE
a variance In accordance with 15A NCAC 2C.0116. /?
11
Is. YIELD(gpm):� _METHOD OF TEST t pe TED / E OF PERSON CONSTRUCTING THE WELL
It
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form GW.1a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rw.7105

NULL CONSTRUCTION 1ZLC
No,U,Calolina-Depathncut of Enviwunicul and Nnlul31 Resources-Division of Water Quality-us ourldwater Section\YELL CONTMCI Olt(INDIVIDUAL)NAalnE (ping PI2�/"D /9 Reece CE1111FICAUUMN 1 D S
IVE1.LCONTIIACIT)rt COaiPANYNAAIE 177111ce teel) /li/Vy nloneNlNZt1 u37-2957
STATE\TELLCONStRUC11ONrEttalilN MUM Ell WO rEltdll'IN .
(if nl, I'c 11 Ir) (Ifnlitdlcnllle)
now
1. WELL USE(Check Applicable Ilus): Itesidculiul U Muolcipul/PubUC U indusllinl U Agdcullulal U
Mulliluling ❑ Recovery U llcal Puuq/Water htjectioii U 011ler U If Older,List Use
2. WELL LUCATION: Topogrnphic/Land scltiug
Ncmcsll'uwn: /1)17A'blC- Cuuuly chexeKeC URdgo vile UVnllcy Ulrlal
i�/) /! 11 yl I- l•,_. (clink eppopilnle box)
(Suer)Home.Numbeu,Community.21,divisloo,Lot No.,7.Ip Gxle) Lalltude/longilude of well luceliull
3. OWNER rRI7N!( Co/U/'0y (Jearea/uJunlee/ennnd')
Address Oo I ._hn r Lutilude/longilude sotuce:UGPSUTUpogln p 1)"'C pu
(Sued a Iloule Nu.) (clink box)
Marbly N( 28RD5 AL►+T11"hll 1 MUNTU L.U_(i
Glynn Town Sule zip Code ►'loth To r/o�mlatioll Descllplioll
D /Q' _AP d
C--)-
A+ra rodr-rhnne ninnbcr /
4. DATE DIUI.LED �l/73Z0j— h- 3 .5 17'e
5. 101'ALOEPTIF /aOO' /
6. DOES WELL REI'LACH CXIS7'INO WELL? YES U NO IU
7. STATIC WATER LEVEL IICIOw Top of Casing•
(Vet-e-if Abow"1 rrp of CoelnN) N
B. TOP OF CASING IS__�-- 1 1'.Above Lmld Sulfacc*
•Top of vJnr lrnnln.led eUnr brloov lend tae Ere tequl+to a O
Vol l.nte In■crordnue ovule ISA NCAC 1C.01IN.
9. YIELD(gill),):_C) ME'IIIOUOF'hESr
10.WATER ZONES (depth): LOU 1011 SKI,Is al
Show direction and dislauce ill miles fion at least
11. C S CASING:
'ION:'1'ype / T H f //c7s Amount ads two Slate Roads or Cooly Roads. Include die road
IZ. CASIIJU"": Wnlweigkurss
l7rptl, Uinuletcr or WcighUft. Mstniat uuulhcta and couunon road Iialucs.
FtolltQfo I°L 5�I f'pG
Flinn Ile FI.
Flout TU FI.
U. GRUUI: Deptl1 Mnlclial Mcdwd
Flout 0_To _ 3 171. ForT/Q�
FlunlTU _O_Fl. /3ctirc . <e )o�ertule
14. SCREW Drptlf Diameter Slot Size Maletinl
From To
Front 'Ile_._FI, hl, iu. I y r
15. SANDIGRAV Ill,PACK:
Orpill Size Mnlelinl
rium I'll_
Flout I'o Fl.
16. RE•NIAIU S:
I DO I IFREOY CEI1 NFY I71AT'II IIS WELL WAS CONSI'I(l)CIP.D IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS 71CI IONSTANUAIIUS,ANDitIATACOPYOFIIIISRiCORDHASBEENPROVIDEDTOTIIEWELLOWNER
RIJ 31112S"
SIGNA'fUIIE Oil PERSON CONS'IRUUI1N(J1IIEWELL DAIS
Sit h[lilt the of Iglunl to the Divislon of Wnlpr(jllnllly,Groundwater Secliun,1636 p1111 Service Colder-itaieigh,NC
17699-1636 rlwar Nu.(919)733-3II1,nilhhl 30 days. OW-1 REV.0712001

r 5AI h
OWNER
35 t. RESIDENTIAL TVELL CONSTRUCTION RECORD MWD
North Caullina Department of Environment wId Natural Resources.Division of Water Quality NO
wELL CON'rltACiOR CEItl'll'ICA'UION H ,'LYQ5,
1.WELL CONTRACTOR: I. DISINFECTION:Type Y t Amoun
f' l g. WATER ZONES(depth):
Well Conueelor(Individual)Name Fran To Fran To
MILLER WELL DRILLING , INC . From To From To
Well Contracts Company Name Fran To From To
P . 0 . B O X 567 G. CASING: Thickness/
STREET ADDRESS Depth Diameter Weight Material
HAYESVILLE NC 28904 i Fran To_FI.
City a Town Stale Zip Code Fran To Ft. _
Fran To FI. __
837-2997 _
Area code- Phone number 7, GROUT: Depth Material Method
2.WELL INFORMATION: Fran To FI.
SITE WELL ID epr applicable) From Tc, Ft
STATE WELL PERMITN(il applicable) From To FI.
DWQ or OTHER PERMIT 9(it applicable) S. SCREEN: Depth Diameter Sid Size Material
From To F1._In, _ in.
WELL USE(Check Applicable Box): RReesidential W aIm Supply D From To_FL_In. _ In.
DATE DRILLED _�/ > Fran To Ft. IT. _in.
TIME COMPLETED
•&Y0Q AM❑ PMp,-� g, SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
From To Ft-.
CITY: - A la+'nl+ _ COUNTY l_l7eT-o ket Fri To FI.
From To FI.
(Sire.,Name,Number.community.SubdMivan.Ld No.,Parcel,Zip Code)
T_O/PS0GRAPHIC I LAND SETTING: 10.DRILLING LOG
L351oPe DValley OFlal ❑Ridge ❑ODIer From To Formation Description
(check appropriate boa)
May be in degrees,
LATITUDE -Z- _ minutes,seconds or
in a decimal kemat t"f
LONGITUDE_ _
Latilude/longilude source: ❑GPS OTopographic map -
(locelbn of"I must be shown on a USGS tope map and p
attached to INS loon IT not uskig GPS) r-Y
UT
4.WELL OWNER
OWNER-SNAME T.J n LSb_rYL.,
STREET ADDRESS 377 R f c)9f LA N C
y r��v Nc Z BGO6
City a T / Stale Zip Code
( F
Ales code- Phonenumber 11. RE,/e 7
MAf 5: ,�� /,
S.WELL DETAILS: / 0�/!1 ICp 0 M 7 c"s
a. TOTAL DEPTH: 7DO 70 1
Ill. DOES WELL REPLACE EXISTING WELL? YES❑ NOE["�
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSMUCH70 N ACCORDANCE WITH
e. WATER LEVEL BeimTop of Casing: ZOQ FT. ISA NCAC IC.WELL CONSIRLICTION STANDMOS,AND THAT A COPY OF THIS
(Use'+*N Above Top ofCaging) RECORD HAS
oBEEN PPRROpVVIDEEDDDTTo THE WELL OWNER. C
d. TOP OF CASING IS _FT.Above Land Surface' !/ -" - �® Ii -�1 -
.Top of casing teminated atlor below land surface may require SIGNATURE OF CERTIFIED WELL CONT RACTOR DATE
a variance in ac dance with 15A NCAC 2C.0110. /, /(/J
m METHOD OF TEST �) FT
ryp " eC��
s. YIELD Igp ): PRINTED ME OF PERSON CONS]FILL;TING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information MUL, Form GW-ta
116117 Mail Service Center-Raleigh,NC 27699.1617 Phone No.(g19)733-7015 exl 568. Rev.7106

NC 0WNER MIN)
WELL CONSTRUCTION MCOM)
14010,Carolina-Dcparinrcul of Lrrvirmuncul mod Natural Resources-Division or Water Quality-Uloundwalcr Secliull n
WELL CONT RACtoll(INUI VIU UAL)HAPIE (prhnOl)l1,4,4 / geese' CEIItIPICA-1 ION r avos'
WELL WNTMCI Oil COMPANY NAME 171 '11ex aytl� -riloNEa (X28) DZ-2997
STATE WELL CONS tRUCi ION rEM11TM ASSOCIA'1"EU WQ PERMI'IN
(if np)rliaiblc) (If npplicnble)__
1. WELL USE (Check Applicable Nun): Residculiai U Municipal/public U InJughial U Agricultural U
Munitotiog U Recovery U Item lump Wnler lujeclion U Other U If0dler,List Use
2. WELL LOCA1ION: / Topogrii )t ul; I-nod Selling
NcorestTorwr �Je,c6le, Couuly G�CRO�PI% DIUJge LISiope UVnllcy Uflal
CWl/1/✓d &ZI (clink eppr"prl.robox)
(sure[Nemr,Numbeu,Cmnmudly,Subdivision,Lot No.,Z11,Cale) Lal{IuJdbngiluJe Orwell location
N a 6L&5 (-Z'v-'
J. OWNER: Fk 191vK re yeo Y (Jertera/minntr�rnondn)
Address a Palw IwvberIle ec _rt3r}0 F}wvIq Lai{ludelimlgiludesuutcc:OGPSOFripoglnphicmap
(Surer a Route(lo.) �� (clink boa)
Mar blE_ t/.� Zgg4 - R.L'171 VRI1- L!Q Lv-Q
City or Town Suite ZaiCale Flour To fornmtiouDescliplion
O /D 1 6///✓,/S
Arta cede-rlmne nioober /� U -�/PT P'
4, DATL• DIALLED442 b101
5. TorAL DEPTH_1r�14
6. DOGS WELL REPLACE EXISTING WELL? )'US U 140 U
7. STATIC WATER LEVEL Uciow Top orCnsiugt
(Use"+"If Above lot,of Cacb,[I' O
B. TOI'OF CASING IS I VI'. Above Loud Sucher• �-
•Ttp oI<nln[Inc ndnded tl/nr below IanJ anlart rtqulnn a fV
varlence In accordance with iSA NCAC IC.01 Is.IEL O
/j p
9. YD(1(Inlll); 0 MET110D 01'1 ES 1 J///` C=)
III.WA7"ER ZONES(11cpl11)t GN_lg�-----------
/1
CASING: Wnll'Ihickncss
Show direction slid distance in miles from st Icast
12. C
I I. S 'ION:"Type HRH Pe//c TJ Annnlyd �S Iwo Stale Roads or Courtly Roads. include Ore road
NO:
Depth ,, Diameter or WcighVfl. Material numbers slid couuoon toad names.
Hoot 1O�,� _11. 5,9A,21 X
From To—H.
flnllr TO ►`I.
IJ. GROU r: Depur Mnlelial McWoJ
1710111 D To 3 rl. �O�T/�Nd /effil, '/Y
From 7 To 6Z_0_1:1. BP aivi t e- prcff al d l�
14. SCREEN: NrpUl Diwneler Slot Size . Malednl
Proof TO rt.-ill. lu.
rtonl__To__f(, lu, in. iPcu y
15. SAND/URAVIII. PACK:
Drpth Size hlnledril c/
hoot ro Pt.
from
16. RLMAMS:
I DO 1IL•REUY CER'flfY TIIAI'1111S WELL WAS CONSI'RUCI ED IN ACCUIU)ANCL WITI1 15A NCAC 2C,WELI,
CONSTRUCNON STANDARDS,ANDTUAT A COPY Of'I111S ItLCORD IIAS ULLN PROVIDLD TO TIW WELL OWNER
SIONA-1URLUFMIRSONCONS'1'IIUCfINUTHPWELL DA1L '
Sul)ndt the 01Igl11n1 to the Ill r1tlan 01 Writ ler Qunilly,Croundwaler Section, I636 DLII Service Corder-hale gh,NC
I7699-1616 Phuor No.[phone],mIthhl 3U dny+. UW-I IILIV.0712UUI

Sf42 v V
RESIDENTML wELL coNsTROCTION RECORD '
North Camhna Department of Environment and Natural Resources-Division of Water Quality � v
WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(IndiNdualt Name Fr= 580' To 586 From Tc
CHEROKEE WELL DRILLING From 650' To 655' From TO-
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: WThickMness/
Depth D ter Notarial
MURPHY INC 28906 From 0' To 40' R.b PVI:
City or Town State Zip Code From To Ft.
8( 28 )_ 837-8008 From To Ft.
Area code- Phone number
7. GROUT: Depth Material Method
2-WELL INFORMATION: From 01 To 20' Ft CEMENT GRAVITY
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(rf applicable) From To R.
DWQ or OTHER PERMIT#(if applicable) 6. SCREEN: Depth Diameter Slot Size Material
From To Ft.—In. in.
WELL USE(Check Applicable Box): Residential Water Supply❑ From To Ft.—in. _ in.
DATE DRILLED 11/O5/05 From To R. in. _ in.
TIME COMPLETED 1:00 AM❑ PM M 9, SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CHEROKEE From To Ft
CITY: MURPHY COUNTY From To Ft
1021 TANGLEWOOD DR. From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
Pope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 18, RED SHALE
May be in degrees, 18' TO 25' YELLOW SHALE
LATITUDE 3 5 07.142N minutes,sacondsm
in a decimal fi m at 25' TO 35' GRAY SLATE
LONGITUDE 84 Ot-439W 35' TO 705' GRAYGRANITEIWHITEQUARTZ
Latitude/longitudesotuce: nGPS ❑Topographicmap
(location of war must be shown on a USGS tope map and rn
attached to this form I not using GPS) (-r1
4.WELL OWNER
OWNER'S NAME RANDY KRESSAL C:)
STREET ADDRESS 1021 TANGLEWOOD RD.
d+
MURPHV NC 28906
City or Town State Zip Code
( 828 1.837-5463
Area code- Phone number
il. REMARKS:
S.WELL DETAILS: BIT SIZE: 6.095
a. TOTAL DEPTH: 705'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I W HEREBY CE"FYTHATTIISWELL WAS CO LCTED IN ACCORDANCE WmH
c. WATER LEVEL Below Top of Casing: 50 FT. 1M NCAC 2C,WELL CONSTRUCTM STANDARDS,ANDTIATA COPY OF THIS
(Use"t•if Above Top of Casing) RE/CO'RD HAS BEEN PROVIDED TOTHE W ELL OW NET
d, TOP OF CASING IS 1 FT.Above Land Surface• / 7 , � - a�lr! 12/07/05
*Top of casing terminated ator below land surface.. require (-SIG ATU RE OF CERTIFIED W ELL CONTR TOR DATE
a variance in accordance wilin 15A NCAC 2C.011&
e. YIELD(gpm): 1 1/2 METHOD OF TEST AIR 1 F��R��Sl. L t<'u 11
PRINTED NAME OF PERSON CONST UCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, Form GW-la
1617 Mall Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 566. Rev.7M5
i

ot4i
DRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources Division of Water Quality
WELL CONTRACTOR CERTIFICATION N 3368
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 1DO PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Wen Contractor(Individual)Name From To From To
CHEROKEE WELL DRILLING From Tc From To
Well Contractor Company Name From Tc From To
STREET ADDRESS PO BOX 1007 G. CASING: WThickMness/
Depth �P er 3g�21 6laterial
MURPHY NC 28906 From 0' To 40' Fl. " F'V(:
City or Town Stale Zip Code From_To Ft.
8( 28 1- 837-8008 From_To Ft.
Area code- Phone number
T. GROUT: Depth Material Method
2.WELL INFORMATION: - From D TO 20' Ft CEMENT GRAVITY
SITE WELL ID tt(if applicable) From Tc Ft.
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT f(If applicable) 8. SCREEN: Depth Diameter Slot Size Material
From TO R._in. in.
WELL USE(Check Applicable Box): Residential Water Supply ix] FromTo I in. — in.
DATE DRILLED 12/12I05 From_To IL in. _ in.
TIME COMPLETED AM❑ PM❑
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
MURPHY COUNTY CHEROKEE From To Ft.
CITY' From To Ft.
HIDEAWAY MTN.OFF TILSON RD. From To Ft.
(Sheet Name,Numbers,Cornmunity,Subdivision,Lot No.,Parcel,Zip Co(e)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
NlSlope OValley LIFlat []Ridge ❑Other From To Formation Description
Icheck appropriate tax) 0' TO 20' RED DIRT TO BLUE SLATE
A'I be m��' 20' TO 40' BLUE SLATE
LATITUDE 3 i a dminutes,sxonrmat
LONGITUDE m a dxvnal fmThlal 40' TO 805' SLATE
Latitude/longitude solace: LGPS ❑Topographic map
(location of wer must be drown on a USGS tope map and
attached to(his form 7not using GPS) p —
4.WELL OWNER tV
OWNER'S NAME CHARLES(SAM)BUZARD _
STREET ADDRESS PO BOX 136 Ln
CULBERSON NC 28903
City or Town State Zip Code
( 828 1-644-0004
Area code- Phone number
It. REMARKS:
S.WELL DETAILS: ADDED 8 FT.PIECE FOR BACK-FILLING
a. TOTAL DEPTH: 805'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I DO HEREBYCERTIFYTHAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
c. WATER LEVEL Below Top of Casing: 150 FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,ANDTHATAC OF THIS
(Use•+'t Above Top of Casing) RECORD HAS BEEN PROVIDED TOME W ELL OWNER
d. TOP OF CASING IS 9 FT.Above Land Surface' / r 12/14105
'Top of casing terminated offer below land surface may require O27) A/� L C/ 7 ���('�
a variance in accordance With 15A NCAC 2C.0118. SIGNATURE OF CERTIFIED W CONTRACTOR DATE
e. YIELD(gpm): 3/4 METHOD OF TEST AIR (.y 1 I r I I A I I
PRINTED NAME OF PERSON CON TRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-ta
1617 Mall Service Center—Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7/05

RESIDENTIAL WELL CONSTRUCTION RECORD
C , s
North Cambna Ihparhnenl of Environment and Natural Resources-Division or Water Quality
• E..fi.•
WELL CONTRACTOR CERTIFICATION# 3368
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
WILLIAM BRADLEY LEWIS g• WATER ZONES(depth):
Well Contractor(individual)Name Fr= To From To
CHEROKEE WELL DRILLING From 7o From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: WThicykIn,tess/
Depth D1 er SFR21 Material
MURPHY NC 28906 From 0' To 58' R.6 PV(:
City or Town State Zip Code From To FL
8( 28 )- 837-8008 From To R. _
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 01 To 20' Ft CEMENT GRAVITY
SITE WELL ID#(if applicable) From To Ft—
STATE WELL PERMITA(it applicable) From To R.
DWQ or OTHER PERMIT t(if appkable) 8. SCREEN: Depth Diameter Slot Size Material
From To Ft. in. in.
WELL USE(Check Applicable Box): Residential Water Supply
From To Ft.—in. _ in.
DATE DRILLED 12/07/05 From To FL—in. _ in.
TIME COMPLETED AM❑ PM❑
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth size Material
From To Ft
CITY: MURPHY COUNTY CHEROKEE From To FG
660 HOLLYBROOK DRIVE From To Ft
(Street Name,Numbers,Commuaty Subdivision,La No.,Parcel,Zip Cade)
TOPOGRAPHIC 1 LAND SETTING: 10.DRILLING LOG
❑Slope []Valley ®Flat ❑Ridge []Other From To Formation Description
(cneckappropria 0box) A'tay�r"��"' 0' TO 0' RED DIRT TO BLACK DIRT
LATITUDE 3 5 2.761N minukxonda a,a or 4
20' TO 0' BROWN SLATE 70 BLUE SLATE
8
84 13.004W m a decimal format 5 ' TO 58' BLUE SLATE
LONGITUDE 58' TO 605' SLATE
Latitude/longitude sauce: f9GPS ❑Topographic map
(location of wel must be shown on a USGS topo map and
attached to this form snot using GPS)
4.WELL OWNER
OWNER'S NAME JAMES ROCHELLE .�
STREET ADDRESS 5237 NICKLE RD.
KNOXVILLE TN 37921
City or Town State Zip Code O
( 865 )_588-6571
Area code- Phone number
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH:605'
b. DOES WELL REPLACE EXISTING WELL? YES[] NO
1 DO HEREBYCERTIFYTIAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WrTH
c. WATER LEVEL Below Top of Casing: 50 FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THATA COPY OF THIS
(Use'*'I Above Top of Casing) RECORD IwS BEEN PROVIDED To THE
1WELL OWNER.
d. TOP OF CASING IS I F r.Above Land Surface' W)I LL����I�bL V [t(12j� 12J14105
'Top of casing terminated at/or below land surface may require SIGNATURE OFSIGNATURE OF CERTIFIED WELL DATE
a variance in accordance With 15A NCAC 2C.0118.
e. YIELD(gpm): 2112 METHODOF TEST AIR ) - r, ' ' - e,4
�'
PRINTED NAME F ERSON CONS U ING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt, Form GW-1a
116117 Mall Service Center—Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7105

d
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina D eparwnent of Environment and Natural Resources Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individuag Name From 220' To 221' From To
CHEROKEE WELL DRILLING From 270' To 271' From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 S. CASING: Thiclmess/
MURPHY NC 28906 From 0' DTt 1
oo 56' FL Meter h'M McMrtal
City or Town State Zip Code From 156' To 160' Ft.6 1/4 -IM— GGVALLV.
8( 28 1- 837-8008 From To FL
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
From 0' To 20' Ft. CEMENT GRAVITY
SITE WELL ID E(if apple ble) From To Ft.
STATE WELL PERMITt(a applicable) From To Ft.
DWQ or OTHER PERMIT i(d apprlcable) 6. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply Ox Froni To R. in, in.
DATE DRILLED 11/30105 From To R.—in. — in.
From To Ft. in, in.
TIME COMPLETED 3:30 AM PM
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To R.
BEE TREE LANE From To Ft
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC LAND SETTING: 10.DRILLING LOG
PloPe ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 75' RED SHALE
May be in dega=,
LATITUDE 3 _ minulea,mcondv or 75' TO 93' BROWN SANDY SFULLE
LONGITUDE ma decimal format 93' TO 100' GRAY SLATE
100' TO 233' GRAY GRANITE/GREEN d WHITE QUARTZ
Lafitude/longitudesource: ❑GPS ❑Topographiemap 233' TO 259 WHITE QUARTZ
(location of we#must be shown an a USGS tape map and 250' TO 270' GRAY GRANITE/WHITEQUARTZ
enached to Min form snot using CPS) 270' TO 340' GRAY SLATE
4.WELL OWNER
OWNER'S NAME ANNE MCKEEVER _
STREET ADDRESS PO BOX 314 -
MURPHY NC 28906
City or Town State Zip Code
( 828 )-557-0642
Area code- Phone number
11. REMARKS: ED
S.WELL DETAILS: BIT SIZE 6.024 Ts
a. TOTAL DEPTH: 340'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO(3
C. WATER LEVEL Below To Of Casin 75 FT I DO HEREBY CEIMFY THAT MS WELL WAS CONSTRUUMD IN ACCORDANCE WITHP 9 1SA NCAC M,WELL COIJSIRUCTION STANDARDS,AND THAT A COPY OF TM
(Use'+•IT Above Top of Casing) RECORD MS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASINO IS 1 FT.Above Land Surface ream' �/ M Y f�� 11/30/05
'Top or casing accordance
with 15A land surface may require NATURE OF CCER ED ELL CON ACTOR DATE
a varenoa it accordance with 15A NCAC 2C.0118. ,.,,I
e. YIELD(gpm): 8112 METNODOF TEST AIR CAVt51QPHER L. NC'
PRINTED NAME OF PERSON CONS RUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attu:Information Mgt, Fo m GW-tor
1617 Mall Service Center-Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality ,
WELL CONTRACTOR CERTIFICATION# 2261
1,WELL CONTRACTOR: If. DISINFECTION:Type CHLORINE AmountioOPPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individual)Name From To From To
CHEROKEE WELL DRILLING Fran To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 S. CASING: Thickness/
MURPHY NC 28906 From 0' De Top
120' Diameter Vey& l rial
R
City or Town State Zip Code From To Ft. 8 7�B
8( 28 t_ 837-8008 From To R
Area code Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
From 0' To 20' Ft. CEMENT GRAVITY
SITE WELL ID 8(if applicable) From To R.
STATE WELL PERMIT9(it applicable) From To R.
DWQ or OTHER PERMIT I(I applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE Check From To Ft._in. _ in.
( Applicable Box): Residential Water Supply
DATE DRILLED 11/29/05 From To R._in. _ in.
From To Ft._In, _ in.
TIME COMPLETED 10:30 AM IVI PM�
'K 9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth size Material
CITY: MURPHY COUNTY CHEROKEE From To FL
From To Ft.
MEGAN LANE From To Ft
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Cade)
TOPOGRAPHIC I LAND SETTING: 10.DRILLING LOG
/`Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Fomtation Description
(checkappropdateboz) minutia,eeamds or 0' TO 12' RED SHALE
May be in okgrm,
LATITUDE 3 5 09.570N 12' TO 43' BROWN SANDY SFL4LE
LONGITUDE 83 55.128W in a decimal format 43' TO 45' GRAY SLATE
45' TO 100' RED SHALE
Latitude/longitude source: P]GPS ❑Topographic map 100' TO 905' GRAY SLATE
(location of wel must be drown on a USGS tope map and
attached to MIS rorm snot using GPS)
4.WELL OWNER
OWNER'S NAME ROCKY BURRELL r
STREET ADDRESS PO BOX 151
ALMOND NC 28702
City or Town State Zip Code
t 828 1-389-9801
Area code- Phone number
11. REMARKS:
5.WELL DETAILS:
a. TOTAL DEPTH:905'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
C. WATER LEVEL BdOW To Of Casing: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSIRUCfED INACCORDANCEWrm
p mg. D FT. I'M NCAC X,WELL CONSTRUCTION STANDARDS,AND THAT A COPY CF THIS
(Use'+'I Above Top of Casing) RECORD HAS BEEN PROVIDED TOME WELL OWNER.
d. TOP OF CASING IS I FF.Above Land Surface* N I r�h`,� 11/30/05
'Top of casing laminated at/or below land surface may require 'SIGNATURE OF C —FIELD WLEL NTRACTOR DATE a variance in accordance with 15A NCAC 2C.0118. ����n���c...,,..�,D(XU1
e. YIELD(gpm): o METHOD OF TEST �A41Lall--7=D1i 1 j
PRINTED NAME OF PERSON CONST UCTIN� G THE WELL
Submit the original to the Division of Water Quality Within 30 days. Attn: Information Mgt,1617 Mail Service Center-Raleigh,NC 276994617 Phone No.[phone] ext 568. Fo mew-1a
Rev.

I
SIAit."-
'� n4 RESIDENTIAL WELL CONSTRUCTION RECORD
( I� North Carolina Deparhnent of Environment and Natural Resources Division of Water Quality
S . w �
WELL CONTRACTOR CERTIFICATION# 3401
1.WELL CONTRACTOR: I. DISINFECTION:Type CHLORINE Amount 10O PPM
JOHN ARTHUR CHASTAIN g. WATER ZONES(depth):
Well Contractor(Individual)Name From To From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 G. CASING: Thickness/
ephMURPHY NC 28906 From 0' DTot 160' FL fteter V�(8�11 Mates®I
City or Town State Zip Code From To R. PVG
g( 28 )- 837-8008 From To Ft
Area code- Phone number
7. GROUP: Depth Material Method
2.WELL INFORMATION: From O To 20' D CEMENT GRAVITY
SITE WELL ID R(if applicable) From To R.
STATE WELL PERMITA(8 applicable) From To Ft.
DWQ or OTHER PERMIT Off applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable B From To Ft. in. in.
Box): Residential Water Supply O From To R._in. In.
DATE DRILLED 11/30/05 From To Ft. in. _ in.
TIME COMPLETED AM❑ PM❑ 9, SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: MURPHY COUNTY CHEROKEE From To Ft
From To Ft.
10DO MOUNTAIN VIEW DR, From To Ft.
(Street Name,Numbers,Communag Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope OValley ❑Fhal ®Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 20' RED DIRT
LATITUDE 3 May be inP deea, 20' TO 80' BROWN DIRT
minutes,seconds m
LONGITUDE to a decimal f.A 80' TO 100' GRANITE/SHALE
— — 100' TO 1a0' BROWN DIRT
Latitude/longitude source: ❑GPS ❑Topographic map 149 TO 160' GRANITE
(location ofwe►must he shown on a USGS lope map and 160' TO 405' GRANITE
attached to this form snot using GPS) -
4.WELL OWNER
OWNER'S NAME VERLINMCDOWELL G9
f"r1
STREET ADDRESS 1000 MTN.VIEW DR.
MURPHY NC 28906
City or Town Stale Zip Code O
a( 04 )_ 713-7089 CM
Area code- Phone number
11. REMARKS:
S.WELL DETAILS 6 FT.GALVANIZED STEEL BOTTOM
a. TOTAL DEPTH:405'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO IH
I DO HEREBY CERTIFY THATTHIS WELL WAS CONSmlIC1ED IN ACCORDANCE WITHc. WATER LEVEL Below Top of Casing: 10D FT. 15A NCAC M,WELL GONSTRUC110N STANDARDS,ANDTHATA c PY OF THIS
(Use'+'i Above Top of Casing) RECORD FRS BEEN PROVIDED TO ME WELL OWNER.
it. TOP OF CASING IS 1 FT.Above Land Surface* -41 ^ I' ,� .1,1 0/OS
'Top of casing terminated atfor below land surface may require - /
a variance it accordance witln 15A NCAC 2C.0118. S N RE OF TIFIED WEL ONTRACTOR DATE
e. YIELD(gpm): 2 METHOD OF TEST AIR �' RT ail ) I
PRINT NAME OF PERSON ONSTRUCTINGTHEWELL
Submit the original to the Division of Water Quality within 30 days. Attn: Informadon Mgt, Form GW-ta
1617 Mail Service Center-Raleigh,NC 276994617 Phone No,[phone] ext 568. Rev.7105

RESIDENTIAL WELL CONSTRUCTION RECORD '
F North Carolina Department of Environment and Natural Resources-Division of Water Quality
-.� WELL CONTRACTOR CERTIFICATION# 3368
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 10O PPM
WILLIAM BRADLEY LEWIS g. WATER ZONES(depth):
Well Contractor(Individual)Name From 160' To 180' From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
MURPHY NC 28906 From 0' DToot 119 Ff.
6De 10521 ter - ial
City or Town State Zip Code From TO R. FVC Mater
8t 28 1- 837-BOOB From To R.
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0. To 20' Fl CEMENT GRAVITY
SITE WELL ID#(if applicable) From_To Pt.
STATE WELL PERMIT#(#applicable) From_To R.
DWQ or OTHER PERMIT#(I applicable) 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply(AFrom To Ft.—in. in.
From To Ft.—
in. _ in.
DATE DRILLED 11/22/05 From To Ft—in.in. _ in.
TIME COMPLETED AM 0 PM a, SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Sae Material
CITY: MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
SUNNY POINT RD.TO PINE WOOD TO LADY LANE From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ®Ridge []Other From To Formation Description
(check appropriate box) � 0' TO 20' BROWN OWN DIRT
May be m degrees, 20' TO 40' BROWN SLATE
LATITUDE 3 minute,aecondv nr
LONGITUDE m a decimal format 40' TO 100' BROWN TO BLUE SLATE
100' TO 605' GRAY GRANITEIWHITE QUARTZ
1 atitude/longitude source: ❑GPS ❑Topographic map
(location of we#romf be shown on a USGS tope map and
attached to this form If net using GPS)
4.WELL OWNER
OWNER'S NAME JOHN P.STEPHENS
STREET ADDRESS 185 OLD FORGE RD.
MURHY NC 28906 —
City or Town State Zip Code -y
82t 8 I.644-9682
Area code- Phone number
11. REMARKS: cn
S.WELL DETAILS:
a. TOTAL DEPTH:605'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I DO HEREBY CERBFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WIm
c. WATER LEVEL Beim Top or Casing: 100 FT. 15A NCAC 2C,WELL CONSmUCTgN STANDARDS,AND THATAC07YOFTHIS
(Use'+•I Above Top of Casing) RECORD WAS BEEN PROVIDED TOTHE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above land Surface' J ��22 11/23/05
'Top of casing terminated Biter below land surface may require SIGNATURE OF CERTIFl D LL CONTRACTOR DATE
a variance it accordance With 15A NCAC 2C.0118. 1 11
e. YIELD(gpm): 11/4 METHOD OF TEST AIR luliuAlu Nm�`,
11 �E,
PRINTED NAME OF PER ON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, Form Gw-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] eat 568. Rev.7/05

RESIDENTIAL WELLCONSTRUCTIOINRECOR
North Camlim Department of Environment and Natural Resources Division of Water Qualityf'
WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individual)Name From 179' To 187' From To
CHEROKEE WELL DRILLING From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 1007 S. CASING: Thickness/
MURPHY NC 28906 From 0' Depth To 73 Ft bp�rrer �sE041 NVEial
City or Tame State Zip Code From To R.
8( 28 ) 837_8008 From To FL
Area code- Phone number
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 0' To 20' Ft. CEMENT GRAVITY
SITE WELL ID#(it applicable) From_To Ft.
STATE WELL PERMIT#(d applicable) From To R.
DWQ or OTHER PERMIT#(B applicable) 9. SCREEN: Depth Diameter Slot Size Material
From To R. in. in.
WELL USE(Check Applicable Box): Residential Water Supply O From To Fl._in. _ in.
DATE DRILLED 11/22/05 From To R.—in. _ in.
TIME COMPLETED 12:30 AM❑ PM px
9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY. MURPHY COUNTY CHEROKEE From To Ft.
From To Ft.
CRYSTAL SPRINGS OVERBROOKANINDCREST From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
RSiope []Valley ❑Flat ®Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 60' BROWN SHALE
May be in degrees, 60' TO 86' GRAY SLATE BOULDER
LATITUDE 3 _ Mimics:seconds or
LONGITUDE in admimalformat 86' TO 179' GRAY GRANITE
— — 179' TO 187' WHITE QUARTZ
Latitude/longitude source: ❑GPS ❑Topograpltiomap 187' TO 405' GRAY GRANITE/WHITE QUARTZ
(bcaton of we#must be shown on a USGS tope map and
attached to this form IF not using GPS)
4.WELL OWNER
OWNER'S NAME SHINEX INTERSTATE DEVELOPMENT,INC. rJ
STREETADDRESS 513BONITOAVE,
NOKOMIS FL 34275 Crl
City or Town Stale Zip Code
( 941 I-223-6248 �n
Area code- Phone number
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH:405'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO 0
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSiRUCiED IN ACCORDANCE W Im
c. WATER LEVEL Below Top of Casing: 4 FT, ISA NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY CF THIS
(Use'+-I Above Top of Casing) RECORD HAS BEEN PROVIDED TOTHE WELL OWNER.
d. TOP CASING IS 1 FT.Above Land Surface' / � �7H� si4 �/!` x 11I28I05
*Top
of casing a atior below land surface may require GNATURE ll IFIE ELL CONT TOR DATE
a variance in accordance vriih 15A NCAC 2C.0118.
e. YIELD(gpm): 100 METHOD OF TEST AIR 1 �RI IM-P It R L�1C
PRINTED NAME OF PERSON CONSTRU TING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt, Form GW-Ia
1617 Mail Service Center-Raleigh,NC 276994617 Phone No.[phone] ext 568. Rev.7105

RESIDENTIAL WELL CONSTRUCTION RECORD
J
North Cantina Department of Environment and Naluml ResDumcs-Division of Water Quality
WELL CONTRACTOR CERTINTCATION# 3186
1.WELL CONTRACTOR: f. DISINFECTION:Type CHLORINE Amount 100 PPM
JAMES ROSE g. WATER ZONES(depth):
Well Contractor(Individual)Name From 210' To 22W From To
ROSE WELL DRILLING From 360' To 380' From To
Well Contractor Company Name From To From To
STREET ADDRESS 7621 NEW HWY.fib S. CASING: Thickness/
Dept 170' s i7i `" l'&o� Kv`8r®1
MADISONVILLE TN 37354 From 0' To R.
City or Twat State Zip Code From 170' To 175' Ft.6114 .188 STEEL
42( 3 1 442-3431 From To Ft
Area code- Phone number
T. GROUT: Depth Material Me81od
2.WELL INFORMATION: From 0 To 29 Ft CEMENT GRAVITY
SITE WELL ID 9(if applicable) From To Ft.
STATE WELL PERMITI(d applicable) From To R.
DWQ or OTHER PERMIT S(ff appfiwble) 8. SCREEN: Depth Diameter Slot Size Material
From To R._in. _ in.
WELL USE(Check Applicable Box): Residential Water Supply O
From To Fl._in. In-
DATE DRILLED 12/29/05 From To R. in. _ in.
TIME COMPLETED 2:00 AM❑ PM ER 9. SAND/GRAVEL PACK:
3.WELL LOCATION: Depth S¢e Material
MURPHY CHEROKEE From To FL
CITY: COUNTY From To Ft.
LANCE ROAD(ACROSS FROM-THE FARM-) From To FL
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC!LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ®Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0' TO 150, DIRTIBROWN SHALE
—— May bee in deg"', 150' TO 175' GRANITE
LATITUDE 3 5 00 min.303N ,xeamd+a
LONGITUDE
8 4 04.551 W mad.imat format 175' TO 400' GRANITE
Latitude/longitudesoTace: (nGPS ❑Topograptticmap -
(location of war must be shown on a USGS lope map and
attached to this form 6not using GPSI -.
4.WELL OWNER N
OWNER'S NAME GALE WITTING
STREET ADDRESS 119 MIMOSA LANE
MURPHY NC 289M
City a Town State Zip Code --
( 828 )_837-9199 '
Area code- Phone number
It. REMARKS:
5,WELL DETAILS:
a. TOTAL DEPTH:400'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
1 DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED,IN ACCORDANCE WITH
a WATER LEVEL Below Top of Casing: 70 FT. 15A NCAC ZC,WELL CONSIRUCTUN STANDARDS,AND THAT A CCPY OF THIS
(Use'+•T Above Top d Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface' /(/I„ „�.0^ 01/06M6
'Top of casing laminated at/or below land surface may require NATURE OF ERTI FIE D ELL CONTRACTOR DATE
a variance in accordance Wth 15A NCAC 2C.0118.
e. YIELD(gpm): 20' METHOD OF TEST AIR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn: nformaR"E I u E D Fom GW-Ia
1617 Mail Service Center—Raleigh,NC 276994617 Phone No.[phone] xt 568. Rev.7M5
FEB o 1 2BBS
Asheville Regional Office
Aoulfer Protection

slnq., V
RESIDENTIAL WELL CONSTRUCTION RECORD
5
North Camfina Department of Environment and Natural Resources Division of Water Quality
b 1 t
WELL CONTRACTOR CERTIFICATION# 2261
1.WELL CONTRACTOR: L DISINFECTION:Type CHLORINE Amnat 100 PPM
CHRISTOPHER L.DICKEY g. WATER ZONES(depth):
Well Contractor(Individual)Name From 240' To 241' From To
CHEROKEE WELL DRILLING From 345' To 346' From To
Well Contract"Company Name From 640' To a1' From To
STREET ADDRESS PO BOX 1007 6. CASING: Thickness/
Depth p�arr�tar ls�� Malarial
MURPHY NC 28906 From O' To 67' R. 6118 FV(:
City or Town State Zip Code From To Ft.
8( 28 1 837_8008 From To R _
Area code- Phone numbs
7. GROUT: Depth Material Method
2.WELL INFORMATION: From 01 To 20' Ft CEMENT GRAVITY
SITE WELL ID#(if appliable) From To R.
STATE WELL PERMIT#(r applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 8. SCREEN: Depth Diameter Slot Sae Material
From To R. F- In.
WELL USE(Check Applicable Beal: Residential Water Supply
From To Fl._in. _ in.
DATE DRILLED 12129105 From To P.—in. in.
TIME COMPLETED 3:30 AM D PM 91 9. SANOVGRAVEL PACK:
3.WELL LOCATION: Depth Sae Materiel
CHEROKEE Fran TO Ft.
CITY; MURPHY COUNTY From To FL
LONE WOLF ESTATES WELL #1 From To Ft.
(Street Name,Numbers,Communiy,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC I LAND S1EfTTING: 10.DRILLING LOG
[]Slope ❑valley ❑Flat pf Ridge []Other From To Formation Description
(check appropriate What) 0' TO 18' RED SHALE
May be in rle®co, 18' TO 23' BROWN SHALE
LATITUDE 3 minul®,i,comuh er
LONGITUDE_ _ kradecmhalfmmat 23' TO 60' BLACK SLATE
60' TO 345' GRAY GRANITEANHITE QUARTZ
Latitude/longitude source: ❑GPS ❑Topographic rnap 345' TO 360' WHITE QUARTZ
(location ofwel must be shown on a USGS tope map end 360' TO 805' GRAY GRANRE/WHITE QUARTZ
attached to this tam/not using GPS) -
4.WELL OWNER
OWNER'S NAME JOHN ENGLAND r, -
STREET ADDRESS 1095 STARLING WAY
nn
VIER4 FL 32955 U1
City a Town State Zip Code
( 321 }633-8180 Ga
Area code- Phone number -
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH: 805'
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I DO HEREBY CERTIFYTHAT THIS WELL WAS CONSTRUCTED INACCORDANCE W mr
c. WATER LEVEL Below Top of Casing: 175 FT. 1M NGAC W.WELL CONSIRLIUDON STANDARDS,AND THATA COPY OF THIS
(Use-+-i Above Top of Casing) RECORD HAS BEEN PROVIDED TOTHE WELL OWNER
d. TOP OF CASINO IS 2 FT.Above Land Surface' /EC Lr;, d0 z-L 01/03M5
*Top of casing terminated ator below land surface may require SSIGNN-AT[.10
URRE CERTIFIED W EL CONT OR DATE
a variance in accordance with 15A NCAC 2C.0118. l/� 1v 1� q1
e. YIELD(gpm): 2112 METHOD OF TEST AIR ` f��.���T�'` F �' is �`-Y
PRINTED NAME OF PERSON CONSTRUCTING 1HE WELL
Submit the original to the Division of Water Duality lthm 3��y�s� : n tlon Mgt, Fam GW-1a
1617 Mail Service Center—Raleigh,NC 276994 17 P 5 ext 56 Rev.7/05
FEB 0 7 2006
Asheville Regional Office

r-
WELL CONSTRUCTION RECORD
North Carolina-Department of Environment and Natural Resources- vision of Water Quality-Groundwater Section
((�� rr7 � � � ��1�tj�}p��� ry
WELL CONTRACTOR(INDIVIDUAL)NAME (print) `-N tF��. + ' ca-y— CERTMCAA71ONE# +y`�
WELL CONTRACTOR COMPANY PHONE # 1�)uDt'���
STATE WELL CONSTRUCTION PERMIT#. ASSOCIATED WQ PERMIT#
ifapplicable) (if applicable)
1. WELL USE(Check Applicable Box):Residential EJ Municipal/Public❑ Industrial❑ Agricultural❑
Monitoring❑ Recovery ❑ Heat Pump Water Injection❑ Other❑ If Other,List Use
2. WELL LOCATION-.
,� Topographic/Land setting
Nearest Towrnv�: 1 "" '��t un� ®Ridge [ Slope Malley ❑Flat
0-14 (check appropriate box)
(Sheet Name,Numbersturnintini&subdivision,Lot No.,zip code) Latitude/longitude of well location
3. OWNER (degreedrainutalseeonds)
Address Vn bnJ Ali Latitude/longitude source:❑GPS❑Topographic reap
n (Street Routeo.) n�� (cheek box)
ult._ P d� DEPTH DRILLING LOG
city or
axg l Zip Code From To Fo tali n es ription
11' _'�' D 10
Arco coda Phone number
4. DATE DRILLED
5. TOTAL DEPTH: '19a
6. DOES WELL REPLACE EXISTING WELL? YES❑ NO E(
7. STATIC WATER LEVEL Below Top of Casing: A�1 FT.
(Use"+"if Above Top of Casing)
8. TOP OF CASING IS FT.Above Land Surface'
'Top of wing terminated atlor below land surface requires a
varlance In accords with with I5A NCAC 2C.0118.
9. YIELD(gpm): _ D OF TEST Aa-
10.WATER ZONES(depth): r-
THg
LOCATION SKETCH
11. DISINFECTION:Type VXT Amount Show direction and distance in miles from at least
12. CASING: pyme Wall Thickness two State Roads or County Roads.Include the road
D Depth h$ Ft X rnr ter or Wei t/Ft. M�telial numbers and common road names.
From (O �p YCC-
Fron To Ft.
From To Ft ° Y — �lrs� VIV,
13. GROUT: Dep Mat al
From Tod Ft.
From To Ft. t p
14. SCREEN: Depth Diameter Slot Sim Material _At'� If
From To Ft. in. in.
From To Ft. in. in. 1 ISSa;�
15. SAND/GRAVEL PACK ':`
Depth Size Material (75
p %�
From To Ft. "
From To Ft.
16. REMARKS:
J m=
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15A NCAC 2C,WELL
CONS7CTION STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WE OWNER
1 14 oS
SIGNATURE OF PERSON CO STRU 7E
Submit the original to the Division of Water Quality,Gr ndwater ff 9)rQ133eft Service C1AShGv1!1lAPs!%nl^naj
VED
27699-1636 Phone No.[phone],within 30 days. Asheville Regional Office 2006
A uifer Protection , r%=--

.?OWNER
r RLTSIDENT/AILAVEI,LCONSTRIIGIN7NREcouu La
Noah Carolina Depann¢nt of Envirunmcnl and Natural Resources-Division of Water MWD
"•u..- Quality
11'ELL CONTRACT CRRTIFICA-1]ON 11 ? yQ� NC ✓
FR:CTOR:
ehiLe I, DISINFECTION:Type /
ef'�C' Amount(Individual)Name 0. WATER ZONES(depth):
R WELL GRILLING , INC . Fr - TO� Fromy To
Company Name Fran 1 '5 To /2F From ToFan To FranESS P . O . BOX js] 6. CASING: To
H AYES VILLE N Depth Thickness
C 28904 I amelerSWe I.I�lew
CI a Town Fran To .S Ft. 2.f ry Stale ZipCWe From
To Ft.
LBZB_} 837-297 Fom To FL Area code- Phole numbW
2.WELL INFORMATION: 7. GROUT: Depth Material
© method
SITE WELL ID AUraPpucable) Fron To .7 FI.eefL !1/d
STATE WELL PERMITy/(ilappticable) Ftom 13 _ 10 4O Fl. e'y)IO'PlIe
---`�+
DWQ or OTHER PERMIT p(ir applicable From, To Ft.
)
0. SCREEN: Depth Dlameler Stiff Size Material
WELL USE(Check Applicable Ooz): Residential Water Supply❑ Forn To FLIn,
/ rim In.
DATE DRILLED !{ -" -� TO FIIn. In,
From FT_in.
TIME COMPLETED, ,3Q AM❑ PM� To in.
3.WELL LOCATION: 9. SANDIGRAVEL PACK:
Depth
CITY: 127UR p COUNTY C ego ee From TO Size Material
FL
FrrRn To Ft. —�--
Frran To FT.
ISbee1 Neme,Nvmben.CanimwJty.SvbdlNflon,Lot No.,Parcel,Zip Code)TOPOGRAPHIC/LAND SETTING
OSlope OValley ❑FIRI ORidge OOther 10.DRILLING LOG
(check appropriale boa) From To Formation Description
LATITUDE May n rhgrm, --------
mintuami ,.ds Of-
LONGITUDE hu rkcinul!Donal G�
Latitude/longitude source: OCI'S ��_—�--
OTppographic map -'-'-'------
(bc°(ion of Hv/must be shown on R USGS logo map and �--
attached 10 this form'i'rl0(usblg GPS) -_MAR 0 200
A.WELL OWNER ny�
OWNER'S NAME Ellljr d -rW�i,7,?j---__ RshBvflte.-Rt3gh3rlai
STREET ADDRESS I r ro action
J _
City p Tam Slate Zip Code --
Area code- PbOne numbw
S.WELL DETAILS: 7 r 11. !JJt!EM1ARK!S:
a. TOTAL DEPTH: c.7. s
b. DOES WELL REPLACE EXISTING WELL? YES O- NOO
C. WATER LEVEL Delcw Top of Casing. FT. I DO HEREBY CERITY THAT THIS WELL WAS CONS1RUCnp NACCplpnrtt;E WIrN
(Use'+'It Above T of Casio ISA NCAC 2C.WELL CONSTRUC1gN STANpARDs.AND nro JNACPY D IPoS
°p 9) RECORD B EN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS FT Above Land Surface' (//
'TOP of casing lerminaled a0or WOW land surface may require IIILLL - /-�
a valance in accordance with 15A NCAC ZC.011 a. SIGNATURE F CERTIFIED WELL CONTRACTOR
4 L)AIE
a. YIELD(gpm); METHOD OF TEST // r('('�.
PRINTED N ME OF PERSDN CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt.,
1617 Mail Service CBntar-Raleigh,NC 27699-1617 Phone No.[phone] ext 568.
Pam G'N-te
Rev.7/05

3T .sine^ .yT -y c n r.. n
DOWNER
If l t_i RE-SIUGNTIAL WELT cyNsruuQJON RECORD MWD
North Carolina Department of Environment and Natural Itcsmuccs-Division of Water Quality (�
NC-4.A.r•net O` �O
11'P,LI,CON'1'ILAC'1'011 CEIt'1'IFICA1170N 9
1.WELL CONTRACTOR: 1. DISINFECTION:Type Amount
/C ercc— 9. WATER ZONES(depth):
Well Contractor(individual)Name From To From Tc
MILLER WELL DRILLING . INC . 'Fran To Fran To
Well Conlrmla Company Name Fran To From To
i
STREET ADDRESS P.0. BOX 5137 E. CASING: Thickness/
Depth Diameter vyqhl Material
HAYESULLE , N . C . 28904 Fr«n_�To7T F1SOR,;Z / pC
City or Town Stale Zip Code Fran To Ft.
( 828 )- 837-2997 From To FT
-
Area code Phone number
T. GROUT: Depth 3' Material Method
2.WELL INFORMATION: d z
Fran
SITE WELL ID Apr applicable) Frorn J' TOZO' FI. '' e. IM417
STATE WELL PERMITNIii applicable) Fran To FL -
DWCI or OTHER PERMIT N(if applicable) a. SCREEN: Depth Diameter Sit Size Maletal
WELL USE(Check Applicable Box): Residential Water Supply❑ From To FL—In. _ in.
r From To Ft.—In. — in.
DATE DRILLED � � —05 Flom To FL—In. _ In.
TIME COMPLETED f iOO AM L9 PM❑
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: /� I COUNTY �{/' Few From To Ft. ` S'
From To Ft.
From To Ff.
(Street Name,Number.Community.Subdivision,Lai No_Parcel,Zip Code)
TOPOGRAPHIC I LANgSETTING: i
10. DRILLING LOG
❑Sipe Ovalley VIA ❑Ridge 00ther From To Formation Description i
Icheck appropriale boa)
Mop IV m rkgrna,
LATITUDE �T _ minutes,secnndx or
LONGITUDE_ in a decimal fiumwl .i
Llliuu1c/lungihldc smucc: oGl'S ❑Topographic map Ep a
(krRfk)rl of"I musf be shown ore a USGS topo reap and _.
attached to this/vole I not uskig GPS) {
4.WELL OWNER 4Vm ph;n9 b1, rd Line
OWNER'SNAME cr, SI 1 nos
STREET ADDRESS 15 rn4Y LR AShOville RegLoftl 0
/l4 Ctio
City mr Town Stale Zip Code
Area code- Phone number
11. REMARKS:
S.WELL DETAILS:
q
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES m/XNO p
e. WATER LEVEL Beim Top of Casing: �1 /I I DO 11FREBY CERIFY 1r1At 11115 WELL WAS CONSTRUCTED a1 ACCOROANCE wrt"
Op g �(/!/ FT. 15A NCAC/r/U/l2�C.WELL CONSMUCTION S1ANDARDS.AND Tw1T A COPY OF THIS
(Use'+'11 Above Top Of Casing) REC D/y3 BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS�_FT.Above Land Surface'
'Top of casing terminated aUa below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE 1.
a variance in accordance with 15A NQAC 2C.0110. `
a. YIELD(gpm):1_METHOD OF TEST_92 2 A'r/ Af /, e f e C--
PRINTED NAME OF PERSON CONSTRUCTING 111E WFI L
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., ram GWAZ
1617 Mall Service Center-Raleigh,NC 27699-1617 Phone No.[phone] 90 560. Rev. 7I05

OWNER
f 1 RESIDENTIAL IVEsLL CONS'I-RUL. IY 0 RFICORD MIND
Nonh Carolina Departnrcnl or Hnvhonmeul and Natural Ilesourccs-Division or Water Quality — ;.=
,7 NC
TVFLL,CONTRACTOR CERTIFICA•PION N � J a
1.WELL CONTRACTOR: 1. DISINFECTION:type /Tr/f Amount
/
/ to —c U. WATER ZONES(depth):
Well Contractor(Individual)Name Flan 7o From io
HILLER WELL DRILLING , INC . Fran To From To
Well Conlrocia Company Name Fran To Fran To
STREET ADDRESS P.O. BOX 507 G. CASING: ihlckr,ess/
Depth Diarneler Weight Malerlal
HAYESVILLE , N . C . 28904 _TojYl FL_N(�,IZ�SO/ pyc
City Town Slate Zlp Cafe Fran/1V To:ICA Fl. LS �kL409 SrCCf
828 837-2997 Ran To rl.
L--}— - -
Area cafe- Phone nurnba
Z.WELL INFORMATION: T. GROUT: Depth Material Mellw
Fran To Ft. PO/"T 79,.(� /�i 2
SITE WELL ID Ipr applicable) Fran �✓ To Z e Ft. VeTk ,7f r
STATE WELL rERMII Nplapplicable) Ran To FL_
DWQ or OTHER PERMIT R(il applicable) 8. SCREEN: Depth Olameler Sid Site Material
'r
WELL USE(Check Applicable Box): Residential Walm Supp1Y❑ Ran To rl. In. In.—
Flan To FL_In. _ In.
DATEDRILLED 1,2-/rV-D iE Ran To FI._In. In.
TIMECOMPLETED J; OU AMP PM(—
9. SANDIGRAVEL PACK:
3.WELL LOCATION: / Depth Size Material
I/ -
CITY: gp4 COUNTY CA,P/2tv��ee rtorn To F 3 1'
� Flan To ft.L
Fran To rL
451,ee1 Nam•,Nanbara,Ca Mu,,,,y.SubdlNalon,Lol No.,pa,cel.Zip Code)
TOPOGRAPHIC I LAND ING: 10.ORIlUN6 LOG
E]S" ❑Valley at Onidge IJOIItor Rom To FormationDescrtplion
(check opproplala boy)
M,y IT In,kyrrcr,
LATITUDE �l _ minmre,rrcnnih m l)
LONGITUDE lot•Aecinml fi,rmN 'FF
LaliludcflongiluJc source LIGPS LlTopngiaphic ntap €FEZ°ETV E ra L f i
fkrnfkr,of"I mrlsf he sboKYl on a USGS ropo nmp and •-;;�
alinched(o Otis form ITrot using Grs)
4.WELL OWNER 'i I'9HI\ 08
OWNER'SNAME I//ll1nM/;,"�/R,11'I'/9Ne 7r0A S
SIT REET ADDRE5S2,Sn26S15rtnmM�blYr} i.!(AQ. Asheville RegLonal
Office
AA �Jl =_ A C zx�1C�_ eCti ?}
City a I own 0' J _Slate Zip Code
Area
ea code ode- rlra,e number
11. REMARKS:
S.WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES el- NO❑ .
ILO❑FnERY CFRIFY THAT THIS WELL WAS CONSMUCIrn INACCrAUAKF..rant I '
e. WATER LEVEL TrAw,Tup of Cnsing, ty T. ISAHCAC Jr,wErt CONVITUCIM RTANVARn9.AM nwr A COPY OF THIS -R.aT
(Use'+'H Above top of Casing)
nECORD HAS BEEN PnOVIDED to THE YYELL OWNER.
, e
d. TOP OF CASING IS I FT.Above Lm,d Surface'
'Tot,of cas6,g taminaled allor below land enlace may require
SIGNATUR F CERI IFIED WELL CONTRAC TOR DAZE
a variance In accordance with 15A NGAC 2C.0118. . T.
a. YIELD tgpm):,�5 _METHOD OF TEST I P\ ll r — /t ec,
PRINtED 14AME OF PERSON CONS TOCTING IHE WELL
Sut)nllt the original to the Division of Water Quality within 90 Clays. Alin: hnlortnallon Mgt.,
1617 hlail ;rrvlce Cpntrr-Ralelyh,NC 27G99-1G 11 t honor No.(919)7J)•7g15¢act 568. rnim GW-110

h •. ��..., .�Wa a� !.e �i v �, �1 OWNER
RL.-si GN1IAL WE'LL CONSTRUC ION RECORD MWD
Norill Carolina Depaltn+cnt of Ell Or onuient and Natural tiesoutecs•Division of Water Quality NC
\\'ISLI.COWFRAC1'Olt CER11FICA110N N -
,,t
1.WELL CONTRACTOR: 1. DISINFECTION:Typo Amoa,,,601 Z-
I n1 11•� �� if C ( .i U. WATER ZONES(depth):
Well Cmltac a(Individual)Name From /66 To /6f Fran To
MILLER WELL DRILLING , INC . Ran 7a To y80 Fran To i
Well Contractor Company Name Plan To From To
t
STREET ADDRESS P.O. BOX 5G7 G. CASING: Thrclnessl
UaPOI Diameter Weight Material
HAYESVILLE , N. C . 2B904 rimn1_To/DO
City a town State Zip Cola Fran To Ft.
L 820 ). 637-2997 Fran To FI.
Area code• Phone number
T. GROUP: Depth Material Method
Rom U To
2.WELL INFORMATION: rl, r00T //P SITE WELL ID 11(pappaca61") (L
Ran_•�To FI. 7Ifir�dN'f[,° i
STATE WELL PERMITLte applicable) Fran To FI.
DWC1 Or OTHER PERMIT L(if applicahlel 6. SCREEN: Depth Diameter Sid Size Material
WELL USE(Check Applicable box): Residential Water Supply U) Fran To FI._i".
/hp / Fran To Ft.-In. _ In. l
DATE DRILLED. Ftorn To FL_In. _ In. `!
TIMECOMPLETED I.,OO AMP PM O--' g. SANDIGRAVEL PACK? •' �
3,WELL LOCATION: Depth Size Material
CITY: /i/77�/z�Y COUNTY Ran Tv FI. � 1
Fran To Ff.
Fran Tv Ft. ' +
ISheen Nano,Nmnbeu C.otunity,Subdivdlon,Lot No.,1'arpeL Zip Coda)
T_OPP9GRAPHIC I LAND SETTING: 10. DRILLING LOG
y'sklpe UValley ❑Plat pRldge ❑other From To FormationDesefiption _.'_�...
(check oppropdala boa)
Mny Ir in dry+rea• r
LATITUDE 11�_,QD• )�d minntre,trrondfer _ +
LONGITUDE �n"l=l$,`Z 7�y in adrrfmol fin,nnl
Litituddlongitude snurre: ❑CI'S Ljopoginphic map O C/'�C V C p
(1rnrk,"of"N musf he slitntu nu n USGS folxn mnp and �„ '
afleched to this htm+L not using GPS) �-�1r
a.WELL OWNER �n O 19061-
OWNER'S
NAME
SiREETADDRESS _/)0�3�q f•
Asheville Regional Offics
Y,F LX ,Vr Zg 2o6 ion s;
City a I n Stale Zip Cale
Area code• Phone nanber "`1
11. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH:
3
b. DOES WELL REPLACE EXISTING WELL?
1DONF"FFY CFn1FY 7NA/Ta9WELLWAp CON91nUC1rDNACC0"LA"CE Wrr"
a WATER LEVEL beMv+TopdCasing _/FT. ISA"CAC 2C,WELL CM11;lRUCN04911ANDMn9.ANDINAIACOnT OF liaa ,i,''�,
(Use'+'H Above Top of Casing) Recon it"BEEN eROVIDED TO THE WELL OWNER. l'
qI.
d. TOP OF CASINO IS / FT.Above!Livid Stalace'
'Top of casing laminnled ago belay land surface may require gIGNATURE OF CERIIFIED WELL CONTRACTOR UAIE ¢ •L,
a miarnce kn accordance wilh 15A NQAC 2C.0118. ,y�/�� p a
*.'YIELD lgprt):�METHOD OF TEST /' J-1_L'!� ���`e� t'
PRINTED NAME OF PERSON CONSTRUCTING 111E WELL '�`"•l
Submit the original to the DIVISIon of Water Quality within 30 days. litho Information MUL, amGw to �:?
1617 I ice C A1a11 Srrvanler-Raleigh r-nu
,HC 2TC99.1611 Phone No.[phone] list 568, 65
:,:

06��51A�lRESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type_ Amount
1 \
C n-xy, g. WATER-ZONES(depth):
Well Contractor(In dual)Name _ From-qk5To ,_!S From To
SAQ'M�iJ\(�`� A�f1\1 ,1Y\( - From To From To
Well Contracto Company Name / \_ From To From To
STREETADDRES`S /O/LY " 6. CASING: Thickness/
Depf From_QTot 4q Ft. Dia e[er Weight ate
Ty`'City or Town State Zip Code From To Ft. _
(1l/� }'�y5- )1 � Fro To Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material ` Method
From ^� To�_Ft. e\ nr ;S4;Ye
SITE WELL ID#(if applicable) From To__Ft.
STATE WELL PERMIT#(d applicable) From To Ft.
DWQ or OTHER PERMIT#(Y applicable) / 8. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply Q� From To Ft.—in. _ in.
DATE DRILLED ) y-Wr From To Ft.—in, _ in.
r - / From To Ft._in. _ in.
AMC] y
TIME COMPLETED J AM PM s 5,
9. SAND/GRAVEL PACK: -
3.WELL LOCATION: Depth Size Material
MM
CITY: 1 r LU.f(�� COUNTY Cher nkr� From To Ft.
\ From To Ft. G
From Tc Ft. �-
(Street rJame,Numbers, munity,Subdidaion,La o.,Parcel,Zip Code)
TOPO�0HIC/LAND SETTING: 10.DRILLING LOG C1
[15lope pvalley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) n [J 5,
May e in — Mike `� ,-
LATITUDE 3 minutes,seconds
conds w
LONGITUDE_ _ in a decimal format 12jr�o ,�jl�ytP
/4� l� 4�Lue tom_
Latitude longitude source: ❑GPS ❑Topographic map
(location of weB must be Shown on a USGS topo map and
attached to this form/not usng GPS) / 07 S `)rat P
4.WELL OWNER
OWNER'S NAME eke- Ulu e " a
STREET ADDRESS �nv tr��,(,xf� � - {�[u .� 61
T_LK1. flu{ .-z,!'. - 2Le
City%Town State*� Zip Code _ _.. _ 7, .._ -.
Area code- Phone number
S.WELL DETAILS: 11. REMARKS:a. TOTAL DEPTH: r) D t) MAY i , A6
Is. DOES WELL REPLACE EXISTING WELL? YES❑ NO 6--�
c. WATER LEVEL Bekwv Top of Casing: I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE wrrH
/D(7-�yp FT. 15A NOAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF INS' -
(Use•+•d Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
- --- -
d. TOP OF CASING IS�_FT.Above Land Surface• Al)*Top of casing la �
terminated atior below land surface may require � ti �' -Ae�Q
a variance in accordance with 15A NCAC 2C.0118. SIGNATURE CERTIFIED WELL CR DATE
e. YIELD(gpm):�_METHOD OF TEST��
1 PRINTED NAmEQF PE SON C
J
Submit the original to the Division of Water Quality within 30 days. Attn:Into Don MqG N ,
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 5 2006 Form W-1a
Rev. /05
DENR-FAYErULLE REGIONAL OWE

RESIDENTIAL WELL CONSTRUCTION RECORD t { .
North Carolina Department of Environment and Natural Resources-Division of Water Quality
1 (Is 1
-. WELL CONTRACTOR CERTIFICATION# t 3
1.WELL CONTRACTOR: f. DISINFECTION:Type Hurl Amount l�:2.
l�n nd �(� (� g. WATER ZONES(depth):
Well Contractor(Indlval I)Name _ From c To, _ From 70
N A e1\ Cam, 1Y\! From Tc From To
Well ContractorCompany Name '\ From 7o From To
STREET ADDRESS 1G4a QV\04 WA, 6. CASING: Thickness/
er Weight Dept ior Material
6Z0 3�U�� Fran_�Tp3FL�DIY�YI2j
City a Tam S`taterr Zip Code From To Ft. 7 _
From To_Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth Material Method
SfTE WELL ID From_0 To�Ft.
#(if applicable) From To Ft -Y-�-1� -K=1tdz�d!
STATE WELL PERMIT#(d applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) B. SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply @-- From To Ft._in. _ in.
DATE DRILLED jj- Aj -Q 'S From To Ft in. _ in.
// 11 From Tc Ft._in. _ in.
TIME COMPLETED �1 AMA PMp�
9. SAND/GRAVEL PACK: -
3.WELL LOCATION: `� / Depth Size Material
CITY: 1 r 1 1 Af Q fw. COUNTY (Z P C gy Fran To FI -
1 ' \ �— From To Ft. - D
I'1\<�b \' 1Y1d fePk _Si1 tV\�ln-n From To Ft.
(Scree me,Numbers,Commundy,Subdmsbn,Lot No.,Parcel ZIP Code)
TOPOWPHIC/LAND SETTING: 10.DRILLING LOG
M-8 opef e p Vall C-
ey ❑Flat, ❑Ridge []Other From To Formation Description �
(check appropriate box) P
LATITUDE 3 [hi
ay be in degas,
—= Ir
inutes_woods a T 2
LONGITUDE a dalmal format -),21 R'y-�\ -
Latitude/longitude source: ❑GPS ❑Topographic map SL(n
00cabon of we#must be drown on a USGS topo map and Tt1nt�Q
attached to this form#not using GPS) r
4.WELL OWNER 1
OWNER'S NAME -Ne-e j kj\Arc� egg's
STREETADDRESS 120Q ;�J(JaTA 1RDC•A AC)l
City To-m7 State ZipCm
Area code- Phone number—(� -�}P S.WELL DETAILS: 11. REMARKS: l
1� /\,['
a. TOTAL DEPTH: / l 5 I /
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO D}-
c. WATER LEVEL Beim Top Of Casing:�`- I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED N ACCORDANCE WITH
g 'D �FT. 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,ANDTHATACOPYOFTHIS
(Use-+^if Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS P FT.Above Land Surface Q I /,/
'Top of casing terminated Ww below land surface may require 3 rr-
a variance in accordance with 15A NCAC 2C.0118. SIG ATURTyOF CERTIFlEU WELL CONTRACTOR DATE
e. YIELD(gPm): METHOD OF TEST IIi
PRINTED NAME PER ON CO
Submit the original to the Division of Water Quality within 30 days. Attn: Inform Bon Mg#Q
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 56 ry I ZrtUJE Form 5
Rev. 5
DENR-FAYFL NLLE REGIONAL OFpCFJ

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
•� �• WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR:
\ I. DISINFECTION:Type J ��"'� Amount 1�c)
�CkYLw Ty(7YY1��nY1 g. WATER ZONES(depth):
Well Contractor In mdual)Name t
\ Fromm a To : From To
1`l 1t1C - FranRS Too From To
Well Contract&Company Name \_ From To From To
STREET ADDRESS "1�� �. 1 ('T O.l\�- 6. CASING: Thickness/ -S
Depth Diameter Weight Material D
From To�2Ft. (z
City or Town State Zip Code From To Ft. ClT
AAi2L} q 5� — 65l5 From Tc Ft.
Area code- Phone number
2.WELL INFORMATION: 7. GROUT: Depth �l Material Method
SREWELLID From�_ToCCQFIL CC)Y\CYe�C �TPc�5if17
it(if applicable) From To FL
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) B. SCREEN: Depth Diameter Slat Size Material
WELL USE(Check Applicable Box): Residential Water Supply 0,/ From To Ft.—in. _ in.
From To Ft. in. _ in.
DATE DRILLED !! K - From To FL_in. _ in.
TIMECOMPLETED_S__ AM❑ PMM�/
9. SANDIGRAVEL PACK:
3.WELL LOCATION: Depth Size Material
CITY: fl)LLw &a COUNTY C)-1 Ct'P_SK From To Ft. -
l�� From To Ft. rn
'-1t CT�-1`c'r nti m Crf-ek 5L bcx Li.-S• nn Front—To—FL
(SVeel:Ye?ne,Nw"nben:,Comunity,Subdivision,Lot No.,Parcel,Zip Code) -�—
TO'PO�GRAPHIC!LAND SETTING: 10.DRILLING LOG
Ibampe 0Valley ❑Flat []Ridge ❑Other From To Formation Description �
(check appropriate box) — (,l' C,n _
May be in degrees,
LATITUDE 3 _ minutes,seconds or !�l-S �1tLP '3 CZY11ht�'e
LONGITUDE in a decimal format )a - )Ll s file P r ri Y\t E P
!L).°D - 12
'Rlu e re T•Tl•3P
LatitudeAongitude source: ❑GPS ❑Topographic map ]R-- a�i _ORue C-trnYitI e
(location of web must be shown on a USGS lopo map and �j fig_ C9 \blur• -r r rr x C
attached to this form MIDI using GPS) _ ��
4.WELL OWNER \\ ,`3Q5- 3US VALtP 62 rn rv't}r
OWNER'S NAME r�P/-2�/� 3� jj]td p_�-Zf Ciht ; P
STREET ADDRESS of W �1)!li Tta fY ty yk B k r ,YN'%ke
"t), \u /\ !L o� 1DL� _1�luo f,re.T\i le
City o T State Zip Code
Area code- Phone number
11. REMARKS:
5.WELL DETAILS: 1Y��r
a. TOTAL DEPTH: 05
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO
I DO HEREBY CERTIFY THAT THIS IN WELL WAS CONSTRUCTED ACCORDANCE W C. WATER LEVEL Below Top or Casing: —I FT. 15A NOAC 2C,W ELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
(Use"+'if Above Top of Casing) RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
d. TOP OF CASING IS 9 —FT.Above Land Surface },�nil- 1/ n'Top of casing terminated aUor below land surface may require SIIGNALTURE O ERTdIFGIEDMW'11Li CONTRACTOR / DATE
a variance in accordance with 15A NCAC 2C.011 B.
e. YIELD(gpm):�_METHOD OF TEST 01.7 y
ff AA�A,II f PERS N C 8TRUCTI G THE WELL
Submit the original to the Division of Water Qualit /05
tCENR-rA
ithin 36M,1.QA@Qstforma n Mgt, Form Gw-la
1617 Mail Service Center-Raleigh,NC 27699-1617 Pe No.[phone] ext 568. Rev. G
YET(ENLLERECICNALOFRCE