GW1-2022-03160_Well Construction - GW1_20220223

F a RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 3073 A
1.WELL CONTRACTOR: g. WATER ZONES(depth):
Rick Crane Top Bottom Top Bottom
Well Contractor(Individual)Name Top Bottom i 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 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: TOP 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#(ff applicable)7562-17-0427 9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply Top Bottom Ft. in, in.
DATE DRILLED 12-29-2021 Top Bottom Ft. in. in.
TIME COMPLETED AM❑ PM I>( Top Bottom Ft. in. in.
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 °?' 701.0000 "DMS OR 3X.XXXXXXXXX DD 0 /64 Clav
LONGITUDE 83 0°e 1675.0000 "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 I
Street Address /
Cashiers NC 28717 / -4.
City or Town State Zip Code / Fr—
Area code Phone number
12. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH:305 �,'
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 AI COPY OF THIS RECORD HAS BEEN
PR DED 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. sMATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 15 METHOD OF TESTair Rick Crane
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 GW-1a
1617 Mail Service Center,Raleigh,NC 27699-161,Phone: [phone] Rev.2/09