GW1-2022-10581_Well Construction - GW1_20221122

RESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2669 [220031
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 126
KENNETH JORDAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 75 To 80 From 635 To 640
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/
Depth Diameter Weight Material
BOONE NC 28607 Fromm Tom_Ft._6 1/R 350 PVC;
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 i Material Method
From 0 To 20 iFt. BENTONIT GRAVITY
SITE WELL ID#(if applicable) From To Ft. 22 BAGS WELL CONSTRUCTION PERMIT#229362 From ITo Ft.
OTHER ASSOCIATED PERMIT#(if applicable) 9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply 5( From �To 'Ft. in. in. -
DATE DRILLED 11/9/2022 From To !Ft. in. in.
TIME COMPLETED 0300 AM O PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEIL PACK:
CITY: BOONE COUNTY WATAUGA Depth Size Material
From To Ft.
HERNDON LN OFF QUEEN ST OFF GREEN HEIGF From I 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 _ _ 36.22646N minutes,seconds or 0 38 RED DIRT SHALE ROCK
LONGITUDE_ _ 81.69273W in a decimal format 38 GRANITP
60 65 GRANITE
Latitude/longitude source: X GPS, u Topographic map 75 80 I SHALE ROCK GRANITE
(location of well must be shown on a USGS topo map and 80 635 GRANITE WHITE QUARTZ
attached to this form if not using GPS) 635 640 I FLINT WHITE QUARTZ
5.WELL OWNER 640 700 I GRANITE
OWNER'S NAME TYLER RAGOR
STREETADDRESS 1725 DUNKIRK DR Nnu n o nn�o
CHARLOTTE NC 28203 1W LULL
City or Town State Zip Code
I (ni%iiaZ(3;f�7 ?i;`;�s3<YdY;y_ UrtA
(614 )_ 565-4615 �,,•Q ;
Area code- Phone number 12. REMARKS•
.5 GPM 75-801
6.WELL DETAILS: 75 GPM 635-640
a. TOTAL DEPTH: 700 i
b. DOES WELL REPLACE EXISTING WELL? YES 0 NODC I DO HEREBY CERTIF, 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: 60 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use'Y'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 SIGNATURE OF CER D jWELL CONTRACT—OR DATE
a variance in accordance with 15A NCAC 2C.0118. KENNETH JORDAN
e. YIELD(gpm): 1.25 METHOD OF TEST AIR PRINTED NAME bF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form Gw-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 668. I Rev.
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