GW1-2022-03158_Well Construction - GW1_20220223

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of water Quality
WELL CONTRACTOR CERTIFICATION# 3073 A
WATER ZONES(depth):
1.WELL CONTRACTOR: g
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 TopO Bottom 117 Ft.6.25 SDR-2 PVC
Franklin NC 28734 Top Bottom Ft.
City or Town State Zip Code Top Bottom Ft.
( 828 ) 524-4976 '
Area code Phone number 8. GROUT: Depth Material Method
2.WELL INFORMATION: TopO Bottom20 Ft.Benonite pumped
WELL CONSTRUCTION PERMIT!#110821-D Top Bottom Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE WELL ID#(d 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 O1-11-202Z Top Bottom Ft. in. in.
TIME COMPLETED AM[I PM I!( Top Bottom Ft. in. in.
4.WELL LOCATION: : 10.SANDIGRAVEL PACK:
Depth Size Material
CITY: Franklin couNTYMacon 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 ❑Other 11. DRILLING LOG
Top Bottom Formation Description
LATITUDE 35 °?' 100.0000 "DMS OR 3X.XXXXXXXXX DD 0 /117 Clav
LONGITUDE 83 0°23 '450.0000 -DMS OR 7X.XXXXXXXXX DD : 117 /355 granite
Latitude/longitude source: 03PS aopographic map /
(location of wall must be shown on a USGS topo map andattached to l
this form if not using GPS) l
S.WELL OWNER /
Carol McClure /
Owner Name /
Street Address /
Franklin NC 28734
City or Town State Zip Code /
Area code Phone number
: 12. REMARKS: (
B.WELL DETAILS: I A Ps .. NE LNi",
a. TOTAL DEPTH:355
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO pI 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
P ED TO THE WELLIOWNER.
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. 8;IGtkATURE7OF CERTIFIE W ELL CONTRACTOR DATE
e. YIELD(gpm): 15 METHOD OF TESTair Rick Crane f
f. DISINFECTION:TypeSterllene 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: [phone] Rev.2/09