386443_Well Construction - GW1_20100819

ELC
yt AUG 312010
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # 4022-A
1 WELL CONTRACTOR
DERRICK SCOTT LEDFORD
Well Contractor (Individual) Name
3(ir°443
g WATER ZONES (depth)
Top Bottom Top Bottom
Top Bottom Top Bottom
CLYDE SAWYERS AND SON WELL DRILL Top Bottom Top Bottom
Well Contractor Company Name
14885 HWY 209
Street Address
Thickness)
7 CASING Depth Diameter Weight Material
Top O Bottom 110 Ft 6 25" 21 PVC
HOT SPRINGS NC 28743 Top Bottom Ft
City or Town State Zip Code Top Bottom Ft
( 828 ) 665-2022
Area code Phone number 8 GROUT Depth Material Method
2 WELL INFORMATION Top 0 Bottom 20 Ft CEMENT POURED
WELL CONSTRUCTION PERMIT# 2010-00272 Top Bottom Ft
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft
SITE WELL ID #(if applicable)
3 WELL USE (Check Applicable Box) Residential Water Supply IV
DATE DRILLED 07-05-2010
TIME COMPLETED 3 30 AM 0 PM El
4 WELL LOCATION
crry CANDLER COUNTY BUNCOMBE
GRASSY VIEW RD CANDLER NC
(Street Name, Numbers Community, Subdivision Lot No Parcel, Zip Code)
TOPOGRAPHIC / LAND SETTING (check appropnate box)
I'Slope ❑Valley ❑Flat ❑Ridge ❑Other 11 DRILLING LOG
Top Bottom
LATITUDE 35 54 9270000" DMS OR 3x XXXXXXXXX DD +1 / 110
LONGITUDE 82 . 75031 0000 DMS OR 7x XXXXXXXXX DD /
110 /345
Latitude/longitude source PS [Topographic map
(location of well must be shown on a USGS topo map andattached to /
this form if not using GPS) /
5 WELL OWNER /
RONNIE WATSON /
Owner Name /
GRASSY VIEW RD /
Street Address /
CANDLER NC 28715 /
City or Town State Zip Code /
828 ) 712-7718
Area code Phone number
6 WELL DETAILS
a TOTAL DEPTH 345
b DOES WELL REPLACE EXISTING WELL? YES ❑ NO CAI
c WATER LEVEL Below Top of Casing 40 FT FT
(Use "+" if Above Top of Casing)
d TOP OF CASING IS 1 FT Above Land Surface*
"Top of casing terminated at/or below land surface may require
a vanance in accordance with 15A NCAC 2C 0118
e YIELD (gpm) 50 METHOD OF TEST RIG
f DISINFECTION Type PILLS Amount 20
12 REMARKS
9 SCREEN Depth Diameter Slot Size Material
Top Bottom Ft in in
Top Bottom Ft in in
Top Bottom Ft in in
10 SAND/GRAVEL PACK
Depth Size Material
Top Bottom Ft
Top Bottom Ft
Top Bottom Ft
Formation Description
OVER BURDEN
GRANITE
AUG 1 4 /fltfl
Information Processing Unit
uvVCl/LIOG
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
ACCORDANCE WITH 15A NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD HAS BEEN
PROVIDED TO THE WELL OWNER
08-12-2010
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
DERRICK SCOTT LEDFORD
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to' Division of Water Quality - Information Processing,
1617 Mail Service Center, Raleigh, NC 27699-161, Phone [phone]
Form GW-la
Rev 2/09