GW1-2022-09559_Well Construction - GW1_20221021

� f RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division ofWater Quality
. e
a ' WELL CONTRACTOR CERTIFICATION# 2669 210194
1.WELL CONTRACTOR: f. DISINFECTION:Type FITH Amount 29
KENNETH JORDAN g, WATER ZONES(depth):
Well Contractor(Individual)Name From 110 To 117 From 125 To 132
DEWEY WRIGHT WELL&PUMP CO., INC From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 308 7. CASING: Thickness/
BOONE NC 28607 Depth Diameter Weight Material
From To 94 Ft. R 1/4 IRS GAI V
City or Town State Zip Code From To Ft.
8( 28 )-264-2651 From To Ft.
Area code- Phone number
2.WELL INFORMATION: 8. GROUT: Depth Material Method
SITE WELL ID#(if applicable) From 0 To 20 Ft. BENTONIT GRAVITY
'From To --___Ft--25-BAGS-- --
WELL CONSTRUCTION PERMIT#328876 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply IX From To Ft. in. in.
DATE DRILLED 09/23/2022 From To Ft. in. in.
TIME COMPLETED_03:00 AMU PM OX From-To-Ft.-in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF BALL BRANCH RD OFF MEAT CAMP/194 From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From TO Formation Description
LATITUDE — — 36.281412 minutes,seconds or 0 72 RED/GRAY CLAY,BOULDERS,GRAVEL
LONGITUDE 81.681387 in a decimal format 72 110 GRANITE
— — 110 117 SHALE ROCK
Latitude/longitude source: X GPS o Topographic map 117 125 . GRANITE
(location of well must be shown on a USGS topo map and 125 132 SHALE ROCK
attached to this form if not using GPS) 132 160 GRANITE
S.WELL OWNER F P '. .--e r
OWNER'S NAME JOSH RIEDER OCTi. gn?2
STREET ADDRESS 207 NEW MARKET CTR#10
BOONE NC 28607 Un,�
City or Town State Zip Code Dy, ULx_i—
(919 )- 397-3709
Area code- Phone number 12. REMARKS:
10 GPM 110-117 10 GPM 125-132
6.WELL DETAILS:
a. TOTAL DEPTH: 160
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 20 FT. RECORD HAS]BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* ��✓l �aoZ
`Top of casing terminated atfor below land surface may require SIGNATURE O RTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KENNETH JORDAN
e. YIELD(gpm): 20 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:lnf rmation Mgt., Form GW-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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