GW1-2022-07474_Well Construction - GW1_20220810

WELL CONSTRUCTION RECORD For Internal Use ONLY:
This form can be used for single or mutiple wells
.WAVER 2.0. S
1.Well Contractor Information:
FROM TO DESCRIPTION
WILLIAM LAWSON 140 ft 142 ft.
Well Contractor Name 230 ft 231 fL
NCWC3491 A ]S�OII---1,( ING or",,nib s veils OR R Aar-cab e.
NC Well Contractor Certification Number FROM TO DIAMETER THICKNES MATERIAL
CHEROKEE WELL DRILLING 0 fL 120 fL 6.125 in- SDR21 PVC plastic
Company Name fL ft. rrt
6. RCA ING O UB geo a closed lop
2.Well Construction Permit#: W2022000338 FROM TO DIAMETER THICKNEs MATERIAL
List all applicable well construction pertmits(re County,State,Variance,eta ft. M in.
3.Well Use: it. ft. in.
on
7.SCREEN
FROM TO DIAMETER THICKNES SLOT SIZ MATERIAL
Industrial/Commercial ft. fL in.
ft. fL in
8.GRUN I
7�
7— 4 G ® FROM TO MATERIAL EMPLACEMENT METHOD&AMOUNT
h-. !!lt�J 0 ft. 20 it.
ft ft
ft ft.
Ijrir�t 9.SDIM
D"JaIsOG FROM TO MATERIAL. EMPLACEMENT METHOD&AMOUN
ft. ft.
4. Date Well(s)Completed: 6/23/2022 Well ID# CRYPTO MINE % ft.
ft. ft
5a. Well Location: 20. G a ch ad ditto a s ee ecessary
List all applicable well construction pertmas fie County,State,Variance,eta FROM TO DESCRIPTION(color,hardness,soil/rock type,grain size,etc)
ANKR MINING SOLUTIONS INC 0 ft. 75 ft. Tan Medium Slate
Facility/Owner Name Facility ID(if applicable) 75 ft. 120 fL Gray Hard Granite SET CASING
3235 HARSHAW RD MURPHY 289M Lot 120 it. 140 ft. Gray Hard Granite
Physical Address,City,and Zip 140 ft. 142 ft. LARGE FRACTURE 10 GPM
Cherokee 550102962103000 142 ft. 230 ft. Gray Hard Granite
County Parcel Identification No.(PIN) 230% 231 ft. SMALL FRACTURE 5 GPM
5b. Latitude and Longitude degrees/minutes/seconds or decimal degrees: 231 ft. 305 ft. Gray Hard Granite
(If well field,one lat/long is sufficient.) 1. _ _ - S
35.065453 N -83.98407 W BIT SIZE 5.87"
6. Is(are)the welt(s): Permanent ;
22. Ce ca 'o
7. Is thus a repair to an existing well: No 6/24/2022
If this is a repair,fill out known well construction information and explain the nature of the Signa of Cerufi Well Contractor Date
repair under#21 remarks section or on the back of this form. By signing this form,I hereby certify that the well(s)was(were)constructed in accordance
with 15A NCAC 02C.0100 or 15A NCAC 02C.0200 Well Construction Slandards and that a
8. Number of wells constructed: 1 copy of tins record has been provided to the well owner.
For multiple i4ection or non-water wells ONLY with the same construction,you can 23. Site diagram or additional well details:
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: 305 OL)
For multiple wells fist all depths if different(example-3@ 200'and 2 @ 1009 SUMITTAL INSTRUCTIONS
10.Static water level below top of casing: 80 (ft) 24a.For All Wells: Submit this form within 30 days of completion of well
Level is above casing.use"+^ construction to the following: i
If Ovate.
Division of Water Quality,Information Procession Unit,
11. Borehole diameter: 6 C—) 1617 Mail Service Center,Raleigh,NC 27699-1617
12. Well construction method: Rotary air 24b.For Infection Wells: hi aadtion to sending the form to the address in 24a
(i.e.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 Quality,Undergroun Injection Control Program,
1636 Mail Service Center,Raleigh,NC 27699-1636
13a. Yield(gpm): 15 Method of test: Air 24c.For Water Sunnly Injection Wells: In addtion to sending the form to
the address(es)above,also submit one copy of this form within 30 days of
13b. Disinfection type: HTH Amount: 100 completion of well construction t the county health department of the county
where constructed.
Form GW-1 North Carolina Department of Environment and Natural Resources - Division of Water Oualitv Revised Jan 2013