GW1-2021-00247_Well Construction - GW1_20210125

WELL CONSTRUCTION RECORD For Imanal Use ONLY:
This form can be used for single or mudiple wells
1.Well!Contractor Information: IL WATER MAW
FROM M DESCRIMION
CRANVAL D LEDFORD 372 R. 373 R.
Well Contractor Name 417 R 418 fL
NCWC4431-A ING weI
NC Well Contractor Certification Number FROM TO DLAX46M Ll MATERIAL
CHEROKEE WELL DRILLING 0 A 50fL 6.13 hL SDR 21 1 PVC plastic
Company Name 0 R Mal. 4.5 in. SCH 40 PVC plastic
16.INNER CASING OR TUBING(geothermal closed Mop)
2.Well Construction Permit#: W202D000453 W202000D452 FROM TO DIAME'n_R IIUCKNES4 MATERIAL.
Lieu aO apDlraWs ass mwWeoan peranits(eCwMy.Stale, Pmiaar,at R, B. in.
3.Wait Use: /r. fL in.
FROM TO DIAMETER SLATS MATERIAL.
Residential iL fir. I.
y ` R fir. in
I&GROUT
FROM TO MATERIAL. MAPLACF.MENf METHOD&AMOUNT
R 20K
1L fi.
NV
fl ft
19.SANIh'GRAVYI.! '
FROM "m MATERIAL F.MPLACFMENTA¢THOD&AMOUN
R ft.
R ft.
4. Date Well(s)Completed: 1/7/2021 Well ED# WELL 2-LOT 7 �-
5s. Well Location: 20.DRILLING LOG(atlarh addHional sheets Ineomsq)
List aS applicable welt construction perverts(ee County.Slap. Variance.et FROM TO DESCRIPTION(color,hardness,soiV ock typo,grain Sim,etc)
SGAP LLC OR 22 R Red Slate
Facility/Owner Name Facility 11)(if applicable) 22IL 50 f1. Gray Hard Granite SET CASING
HIWASSEE CREEK ESTS MURPHY 28M Lot 7 W WASSEE CREW ESTATES 50 it. 372 IL Gray Hats Granite
Physical Ad&m.Cry,and 2W 372R 373 R Gray Fractured Granite FISSURE GPM
Cherokee 4561001839900DO 373R. 417 R. Gray Hard Grange
county Parcel Weeldiaim No.(PM 417 fir 418 IL Gray Fractured Grange FISSURE GPM
Sb. LsWnde and L angifade degreelt lseaeds or decimal degrpx: 418 ft. 705 f. Gray Hard Grange
21.REMARKS h.
(If will Ld4 one Iallorg assufficient.) .:.:.. r -
35.06752 N -84.14479 W Brr SIZE 5.931"
6. Is(am)thewetl(s): Permanent --
2 2. Bcation:
7. Is this a repair to an existing well: No 1/11/2021
Ifths u a repair,fill out kmroan wit meusbuctiae it formation and explain the rmmre ofthe S' .eW ed -Ater ate
repair uMer#21 remarks section won the back ofthts farm.
By sigrtrmg irks form,!hereby certify Out the wel[(sf was/werel caepvveted in aecrordance
with 15A NCAC 02C.0100 or 15A NCAC OTC.0200 Well Construction Standmds and dua a
& Number of wells constructed: 1 ropy oftlts record has been prmidedb On wit owner.
Fw muldpk igechon or roe-watt wells ONLY with the same cwuirvcaon,you emm 23. She diagram or addKfonal well detatia:
submit one form You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
9.Total well depth below land surface: 705 (ft)
For enulvple »ells lest ell depth.i,fdfferem(erannple-3@ 200'and 1 Q 100') SUMITTAL INSTRUCTIONS
10.Static water level below top of acing: 60 TO) 24s.For All Wells: Submit this form within 30 days of completion of well
Ifwu vel i ter les abase cosiest,use"I" e n L construction to the following:
w� Division of Water Quality,Information Procession Unit,
11. Borehole diameter: 6 010 1617 MOB Service Center,Raleigh,NC 27699-1617
12. Weil construction method: Rotary air - 246.For lalection Wells: In addtion to sending the form to the address in 24a
tie auger,rotary,cable,direct push etc.) above,also submit a copy of this form within 30 days of completion of well
construction to the following:
FOR WATER SUPPLY WELLS ONLY: Division of Water Qaalky,Undergreao Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
13a. Yield(gput): 2 Method of test: Air 24c.For Water Supply Infection Wells: In addtion to sending the form to
the address(es)above,also submit one copy of this farm within 30 days of
136. Disinfection type: HTH Amount: 100 completion of well construction to the county health department of the county
where constructed.
Fom GW-I North Caselma I7wmmrmt of Envhonmau ant Natural Resources - Division of Water O.Ixv Revved Ten 2013