GW1-2022-01771_Well Construction - GW1_20220223

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RESIDENTIAL WELL CONSTRUCTION RECORD
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North Carolina Department of Environment and Natural Resources-Division of Water Quality
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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 Top Bottom Top Bottom
Well Contractor Company Name
Thickness/
248 Crane Circle 7. CASING: Depth Diameter Weight Material
Street Address TOP Bottom 117 Ft.6.25 SDR-2 PVC
Franklin NC 28734 Top Bottom Ft.
City or Town State Zip Code
( 828 ) 524-4976 Top Bottom Ft
Area code Phone number 8. GROUT: Depth Material Method
2.WELL INFORMATION: : Top.Q Bottom 20 Ft.Benonite pumped
WELL CONSTRUCTION PERMIT#110821-D Top Bottom Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID#(If applicable)6489669578 9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply Top Bottom Ft. in. in.
DATE DRILLED 01-11-2022 Top Bottom Ft. in. in.
�./ Top Bottom Ft. in. in.
TIME COMPLETED AM❑ PM l�f
4.WELL LOCATION: : 10.SAND/GRAVEL PACK:
CITY: Franklin COUNTYMacon Depth size Material
: Top Bottom 'Ft.
Calvary Drive 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 []Other11.DRILLING LOG
Top Bottom Formation Description
LATITUDE 35 °2' 100.0000_. "DMS OR 3X.XXXXXXXXX DD 0 /117 Clav
LONGITUDE 83 Q°23 '4W.0000 "DMS OR 7X.XXXXXXXXX DD 117 /355 granite
Latitude/longitude source: 0GPS Qropographic map /
(location of well must be shown on a USGS topo map andattached to l
this torn if not using GPS) l
S.WELL OWNER /
Carol McClure /
Owner Name /
Street Address /
a,
Franklin NC 28734 / E 1
City or Town State Zip Code /
Area code Phone number
12. REMARKS: i
6.WELL DETAILS: 4-4 I �)
a. TOTAL DEPTH:355 y x-
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO pf
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below Top of Casing: 80 FT. ACCORDANCE WITH 15A NCAC 2C,WELL CONSTRUCTION
(Use"+"if Above Top of Casing) STANDARDS,AND THAT A COPY OF THIS RECORD HAS BEEN
: MPED TO THE WELL OWNER.
d. TOP OF CASING IS 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. SIG TURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 15 METHOD OF TESTair 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 GW-1a
1617 Mail Service Center,Raleigh, NC 27699-161,Phone: [phone] ! Rev.2/09
i '

RESIDENTUL WELL CONSTRUCTION REGORD
5 ' North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3073 A j
P `
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 TOP 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 Tap Bottom Ft.
City or Town State Zip Code
( 828 ) 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#010121-D Top Bottom Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID#(ff appllcable)6571816099 9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply Top Bottom Ft. in. in.
DATE DRILLED 01-31-2022 Top Bottom Ft. in. in.
Top Bottom Ft. in. in.
TIME COMPLETED AM❑ PM Y
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
Depth Size Material
CITY: Franklin couNTYMacon Top Bottom Ft.
off ShODe Road ToP Bottom Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) Top______Bottom Ft.
TOPOGRAPHIC/LAND SETTING: (check appropriate box)
❑Slope oValley ❑Flat ❑Ridge pother 11. DRILLING LOG
Top Bottom Formation Description
LATITUDE 35 °_' "DMS OR 3X.XXXXXXXXX DD 0 /64 Clav
LONGITUDE83 0° "DMS OR7X.XXXXXXXXXDD : 64 /505 granite
Latitude/longitude source: ❑3PS Oropographic map /
(location of well must be shown on a USGS topo map andattached to /
this form if not using GPS) l
S.WELL OWNER /
Paul Cook j
Owner Name /
Street Address /
Franklin NC 28734
City or Town State Zip Code /
Area code Phone number
12. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH:505
b. DOES WELL REPLACE EXISTING WELL? YES❑ 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
: PRO ED TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface'
"Top of casing terminated attor below land surface may require 2-15-2022
a variance in accordance with 15A NCAC 2C.0118. SIGNATURE OF CERTIFIEDIWELL CONTRACTOR DATE
e. YIELD(gpm): 20 METHOD OF TESTair Rick Crane
f. DISINFECTION:Type Amount PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality- Information Processing, Form GW-1a
1617 Mail Service Center,Raleigh,NC 27699-161,Phone: [phone] Rev.2/09
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