GW1-2022-02949_Well Construction - GW1_20220301

WELL CONSTRUCT19N RECORD For ltatmt Use ONI-t:
Tlrts fozrttt:att 1m owd free single m"Makik netts
1.Weil Cantr amr rttfonnation:
, Chris Ruffer VRny I7tt rat st ttF
Svc1tC�+ttraKtttrkatttt tl: n.
h. n.
4223 A
i t .: ti iebs*ag"l m` t' .W;.;,
HC 4Wc1tC ortrstsarCcrtiftlian"[iutticr
rRttsr I TO neAsttcTM TittC'rrye•�€ _><tATERTA1a
SARDACCO inc M n. Itt
t: tw NAM :r all rnta iseits$c
:+FROM TO DF1\tr raR 7"La. )HATE 4
2.Well Constractip"Pcrmit k:- 0 ft. 78 ft. 1 in Sch 80 PVC
Litt at,'amliiotde welttwnffttr Ox.Ctemtm.Shin.tizrimm Il1h5C9t1R arr.0
0 Q- 53 a 1 in hL Sch 80 PVC
3.Wc�tt#Se felteel:�etl aact: x,17 � h
Water Supply Well: 78
Tat mAMKTP_a. SIOM71 t#it'ritttM.� btATHRIM.
78 q 80 it. 1 is io 01-0 SS
ClAgrictthttrrt L:lhtuflicipstt'Ptdtitc
OGmknrtitl(HamingCoobng Suppls) DResidetnial W mef Supply-(single) 53 it. 55 R. 1 in tit. O10 SS
17NttlasttislKamtt rciat ClRtsidemta WaterStml}%handl
M. DfA rbi, `_ ,_!tt►t.AG'r°°1HF1T ,. tt8 d AMpL`�T
❑ini tion 0 n. 40 n. Portland Tremie
ikon-Wsfcr Supply We":
ft, 4.
f]A2aaitoritts+ IRRecov�cn
Injm1oft ell:
DAgnifor Recharg lRCaroitndtrtte[Rco dimian
rnOM- ATE tztl. t!at�at�t�t�t�►e0p.
AAgttlfcrStomgcafdRecaimn, OSalintmBanicr 75 n. 80 W Sand #2
DAquifcrTest OStntmnatcr Dm rug 50 ft, 55 tt. Saari i]2.
❑expedmenud Techoohm OSub4isktrce CoxaMl
Q tt�lttktsitiri„ t1u�h if
OGeodtentOi(Clrtsed,LOW OTtacer FROM TO tsrscat�rra•�e.r.r.r.rat�.+ota�t+:` ..�
OGeoti emm!(termer Eadi Rcntmi 00t1rr(vtom under#2 t Renm&r) n �.
n ft.
4.Date Weli(sl Com pleted: 1-26-2022 Wail r1)+I0I-2.5
Sri.Well(.iteation: See Gap s Note4t,
Moog n, n. p a t
Feted t),*%mr Nmm Fxt iW 1I?40 Ofaaptimict m.. .�. -B
ft. fr: " V�jgR
1995 NC Hwy 141 Murphy, NC 28906 Cherokee County, n•, a.
Murphy, NC, 28906 Ph}s dAddms Cin-..attd4ip 2 ,R
Cherokee
f"etterfh' ltimcI I&mtfim1iOm Nd (PIN$
5h.lAtitude and IAnghadcin degrecOminatWseersndsor ttedmat dcgmca: 1L f.1 aim:
Of wait&M,tsars tar14iv is zrrtti, std;
N W Chris Ruffer _ w__.., 1/26/2022
4 mtmt ofCcttlfstd W tU Ctlnmctnr Date
6.ir`(are)the wcff(s): XPerma nem or 07mtpttrary &,,g„r'nr A"Amm t vet;+re r ;ilrru r{u�rthst rt�r r rri< err exea�.i� i r ,tr
nrrh t:fA tvCAC tldf,t3t!�rer t 9A NGAC"tl;t:'<AJik7 it°rtt Z'r,nxrmr brut Ser++darcfs rtru!r{enr cr
7.is(iris a mpair to an existing%yeti: Ones or KNo E«�r t!f tees ro.+r1f fret ts�s pme rkd rn the ie�N sru�ur,
f}rhts es ra re�vr.(r{p r�r twrnsn+pelf.zKse�rtrrti�mt rnfirrr�rdrn aar{rr�lnt�rkr rurrrre r jrlir
r r;r rsaalrr air a et:rf�- , no tothe he C.of tttkr .r.. 23.Site diagram or additional w di details: _
You tang fate the but;of this pate to OmOde additional well site deaths or ftell
R.Namberof recite t:att sir mted-2-. ccrosttuttion drtstiis. t'ou eta also aitaelr�tliticit l pates el r ieSsary'.
f"t=r aornht,{etor�{erttnn deb rxtH-urtror �i.eawitr O�'f F'aah tico�rma ronstrerstka.>=.ac�gas
se:tmrir rater}imu< IlN Cr'CAL KtlS't'[C["I M
9.Total"di dcVMbelo%v land surfam 80 ((Ll 24a. For Alt Melts: Subuit this:famn within 3ts4n%s,of cmaptetion,of%vtlt
V.Ar m sir plc we{tt tier 44opshr t fihfi?rrm mmoo k-30-200'curt 20-41 ! con5mmiifin to(ht'folloving:
to.Static water level heiotw capef casim Nt.t ft ivion of Water Rewurces,Iaforma@on�Unit,
tfnvile?InrI tv dhoro. ar't.urr �" 1617!►fait Sot tee i inter.IMIdo.NC 21609 4617
11.Bcrrcttote diamct :8 is (ire) 14b.Par tit�+; ONLY: 3n addition to scWing the form t0 Ow addrm in
24mAme. also sabtWi a copy of this form within V ttai't of cvtir dwtl of well
12.Well conamctim Method:Sonic cattstnutiun to the foliotving.
eat.imm.cahh:,direct fusels,rn.t
AfhWtt®f Water tieamrfrc5.DnderAtxtund ittjedttttt CrTntt7nt:Pror,
FOR WATER SUPPLY WEM ONi.Y:t 1630 Ma Smice renter.Rmfd*NC.276"-l636
t3a.Vidd t-glam) 14Smbod of ft--M 24e.For NVater SamOv&Weditm Welts'
Atsd subodt one 'Of ft limn within 10 d*SO(Compleliotiol
13b.DisiaFoction trpr >,K Anttrunt•• %veil contraction to the county hcmbh delman to of the coonls'ahem
..u.
coat5tntctml.
Fens!ii4�'-1 NontiCvalma Dqmnvnlof.Em uwutma aid Natutsl.Recoums-Di!Sion of Water Renr em Itet iced Ate 2013