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HomeMy WebLinkAboutGW1-2022-01770_Well Construction - GW1_20220223 -t' f RESIDENTL9L WELL CONSTRUCTION RECORD !, North Carolina Department of Environment and Natural Resources-Division of lWater Quality r °`° ` WELL CONTRACTOR CERTIFICATION# 3073 A 1.WELL CONTRACTOR: g. WATER ZONES(depth): Rick Crane Top Bottom Top Bottom Well Contractor(Individual)Name Top Bottom Top Bottom Crane Bros. Well Drilling Tap Bottom Top Bottom Well Contractor Company Name Thickness/ 248 Crane Circle 7. CASING: Depth Diameter Weight Material Street Address TOP 0 Bottom 64 Ft.6.25 SDR-2 PVC Franklin NC 28734 Top Bottom Ft. City or Town State Zip Code 8( 28 ) 524-4976 Top Bottom Ft. Area code Phone number 8. GROUT: Depth Material Method 2.WELL INFORMATION- TOPO Bottom20 Ft.Benonite pumped WELL CONSTRUCTION PERMIT#2021-20947-9-10930 Top Bottom Ft. OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft. SITE WELL ID#(if applicable17562-17-0427 9. SCREEN: Depth Diameter Slot Size Material 3.WELL USE(Check Applicable Box): Residential Water Supply @f Top Bottom Ft. in. in. DATE DRILLED 12-29-2021 Top Bottom Ft. in. in. Top Bottom Ft. in. in. TIME COMPLETED AM❑ PM(� 4.WELL LOCATION: 10.SAND/GRAVEL PACK: Depth Size Material CITY: Cashiers COUNTYJackson Top Bottom Ft. off Laurel Knob Road Top Bottom Ft. (Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) TOP Bottom Ft. TOPOGRAPHIC/LAND SETTING: (check appropriate box) []Slope ❑Valley ❑Flat ❑Ridge ❑Other 11. DRILLING LOG Top Bottom Formation Description LATITUDE 35 Qr 701.0000 "DMS OR 3x.XXXXXXXXx DD 0 /64 Iclav LONGITUDE 83 Imo°8 '875•ODDO "DMS OR 7X.XXXXXXXXX DD : 64 /305 granite Latitude/longitude source: FPS propographic map / (location of well must be shown on a USGS topo map andattached to / this form if not using GPS) l 5.WELL OWNER / Janet Bryson / Owner Name / PO Box 1112 / Street Address / Cashiers NC 28717 City or Town State Zip Code / e °' Area code Phone number 12. REMARKS: 6.WELL DETAILS: a. TOTAL DEPTH:305 b. DOES WELL REPLACE EXISTING WELL? YES p NO I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN c. WATER LEVEL Below Top of Casing: 40 FT. ACCORDANCE WITH 15A NCAC 2C,WELL CONSTRUCTION (Use"+"if Above Top of Casing) STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN : 7PRDED TO THE WELL OWNER. d. TOP OF CASING IS 1 FT.Above Land Surface' 'Top of casing terminated at/or below land surface may require 2-15-2022 a variance in accordance with 15A NCAC 2C.0118. SI TURE OF CERTIFIED WELL CONTRACTOR DATE e. YIELD(gpm): 15 METHOD OF TEST air Rick Crane f. DISINFECTION:Type Sterilene Amount PRINTED NAME OF PERSON CONSTRUCTING THE WELL Submit within 30 days of completion to: Division of Water Quality- Information Processing, Form GWAa 1617 Mail Service Center, Raleigh,NC 27699-161,Phone :(919)807-6300 Rev.2/09