GW1-2022-03773_Well Construction - GW1_20220404

`! RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#3073 A
I� ;
1.WELL CONTRACTOR: g. WATER ZONES(depth):
Rick Crane : Top Bottom !' Top Bottom
Well Contractor(Individual)Name Top Bottom l Top Bottom
Crane Bros. Well Drillina Top Bottom Top Bottom
Well Contractor Company Name Thickness)
248 Crane Circle : 7. CASING: Depth Diameter Weight Material
Street Address TOP Bottom60 Ft.61/4 SDR-2 PVC
Franklin NC 28734
Top Bottom Ft.i
City or Town State Zip Code
Top Bottom Ft.1
828 524-4976 1
Area code Phone number : 8. GROUT: Depth I. Material Method
2.WELL INFORMATION: TopO Bottom20 'Ft.benonite pumped
WELL CONSTRUCTION PERMIT#032722-D Top Bottom Ft.
OTHER ASSOCIATED PERMIT#(if applicable) Top Bottom Ft.
SITE'WELL ID#(if applicable)65566823035 9. SCREEN: Depth ; Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply ly Top Bottom Ft. in. in.
Top Bottom Ft.l in. in.
DATE DRILLED03-25-22 i� I
TIME COMPLETED AM❑ PM a Top Bottom 1 in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
Depth Size Material
CITY: Franklin COUNTYMacon Top Bottom Ft:
Olive Hill Road Top Bottom Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) Top Bottom jFti
TOPOGRAPHIC/LAND SETTING: (check appropriate box) f i
❑Slope ❑Valley ❑Flat ❑Ridge []Other 11.DRILLING LOG {;
Top Bottom ii Formation Description
LATITUDE 35 °_' "DMS OR 3X.XXXXXXXXX DD 0 /60 Ibay
LONGITUDE 83 '� °_' "DMS OR 7X.xxxxxxxxX DD : 60 /330 )granite
Latitude/longitude source: (]3PS Oropographic map /
(location of well must be shown on a USGS topo map andattached to /
h ;
this form if not using GPS)
6.WELL OWNER
Junior Burch i APR - 4 2022
Owner Name /
Olive Hill Road I "
Street Address / (°P 4ytii�3i\t!,
Franklin NC 28734 /
City or Town State Zip Code
Area code Phone number �I
12. REMARKS:
6.WELL DETAILS:
a. TOTAL DEPTH:330 is
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO N'
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN
c. WATER LEVEL Below Top of Casing: 30 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 THE D TO THE WELL OWNER.
d. TOP OF CASING IS FT.Above Land Surface'
*Top of casing terminated at/or below land surface may require 03/30/22
a variance in accordance with 15A NCAC 2C.0118. SIGNATURE OF CERTIFIED 4WELL CONTRACTOR DATE
e. YIELD(gpm): 20 METHOD OF TEST Ir Rick Crane
f DISINFECTION Type Amount PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days df completion to Divtslon of lNater Quality Info`rmatton Processing, Form GW-1a
<9617 Mail Service Center,Raleigh,NC 27t99 161 Phone [phone]y Rev.2/09