Driller Report Summary

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Well Number: 20221501
Driller Tag Number: BA4700
Inspection Tag Number: -
Date Received: 06/28/2022

License Number: 639
Driller Name: Rickey Dale Samples
Rig Operator: JARED LANE

County Name: JEFFERSON
Driller Map No.: 2FZ
Quad Name: WHITE-PINE
Quad Number: 0163SE
Quad Nth: 3
Address: 3204 JARNIGAN ST
Address Line 2: -
City Name: WHITE PINE
State Name: Tennessee
Zip: 37890
Zip Ext: -
Distance From Landmark (miles): -
Direction From Landmark: -
Nearest Landmark: -
Latitude: 360601
Longitude: 831649

Date Drill Rig Left Site: 05/04/2022
Type of Work: Backfill and Abandon

Completion Date: 05/04/2022
Total Depth (ft-bgs): 79
Depth To Bedrock (ft): -
Static Level (ft-bgs): 5
Estimated Yield (GPM): -

Depth (ft-bgs)	GPM	GPH	Water Quality
-	-	-	-

Tested By: -
Static Level (ft-bgs): -
Pumping Level (ft-bgs): -
Test After Hours: -
Test After Mins: -
Test Yield (GPM): -
Hours Prior to Test: -
Minutes Prior to Test: -

Depth from (ft)	Depth to (ft)	Description
-	-	-

Company Name: -
Owner Name: J.C. LANE
Address: 3204 JARNIGAN ST
Address (Line 2): -
City: WHITE PINE
State: Tennessee
Zip Code: 37890

Well Use: Residential

Diameter (in): 6
Top Set (in-above ground): -
Primary Casing Depth (ft-bgs): -
Primary Casing Type: -
Wall Thickness: -
SDR#: -

Well Finish: -
From (ft-bgs): -
To (ft-bgs): -
Screen Type: -
Slot Size (in): -
Gravel Pack From (ft-bgs): -
Gravel Pack To (ft-bgs): -

Back Fill Type	From (ft-bgs)	To (ft-bgs)
-	0	0

Type: -
Diameter (in): -
From (ft-bgs): -
To (ft-bgs): -
Packers Installed?: -
Packer 1 Depth (ft-bgs): -
Packer 2 Depth (ft-bgs): -

Appearance: -
Taste: -
Odor: -
Other: -

Well Disinfected?: -
Well Capped?: -
50ft From Septic System?: -
Septic Distance Provided By: -
Drilling Process Water Obtained From: -
Pump Installed By Driller?: -

Comments: pump and piping removed, casing left in place and cut below ground level, no liner, 1/2 gal chlorine, backfill: 3/8 in bentonite chips 0-79 22 50 lb bags gravity, utility water