GW1-2022-10707_Well Construction - GW1_20221205

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RESIDENTML WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2669 220093
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 84
KENNETHJORDAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 80 To 83 , From 210 To 213
DEWEY WRIGHT WELL&PUMP CO., INC From 410 To 415 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 Ft. R 1/8 350 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 Material Method
-SITE WELL ID#(if-applicable) - - From 0 To 20_Ft. BENTONITI GRAVITY
From To Ft.'-1-8-BAGS'
WELL CONSTRUCTION PERMIT#753384 From To Ft. a
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 11/22/2022 From To Ft. in. in.
TIME COMPLETED_03:00 AM 0 PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BANNER ELK COUNTY AVERY Depth Size Material
From To Ft. F—
LOT#48 OFF EAGLE CAMP OVERLOOK OFF LODG From To Ft "'� �wc�•-a �s' Is_� u
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:' r 4
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box) 1-1. DRILLING LOG tn` -- '� i Ur 1
vi ri'3 1 1 t r,.. t•
May be in degrees, From To Formallon Descrjp"QMG
LATITUDE _ _ 36.20238N minutes,seconds or 0 12 BROWN DIRT,SHALE ROCr(
81.91583W in a decimal format 12 80 GRANITF
LONGITUDE_ _ 80 83 SHALE ROCK
Latitude/longitude source: X GPS 0 Topographic map 83 210 GRANITE,PINK SLATE
(location of well must be shown on a USGS topo map and 210 213 SHALE ROCK,PINK SLATE
attached to this form if not using GPS) 213 410 GRANITE,PINK SLATE
5.WELL OWNER 410 415 PINK BROWN SLATE
415 500 GRANITE PINK SLATE
OWNER'S NAME BOB SELEE C/O SKYHOUSE CONST
STREET ADDRESS 2874 TYNECASTLE HWY
-BANNER ELK NC 28604
City or Town State Zip Code
(828 )- 898-3717
Area code- Phone number 12. REMARKS:
.25 GPM 83-83
6.WELL DETAILS: 2.75 GPM 210-213
a. TOTAL DEPTH: 500 g GPM 410-415
b. DOES WELL REPLACE EXISTING WELL? YES 0 NON 100 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: 100 FT. RECORD HA§BEEN PROVIDED T9vTHEWELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS I. FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATURE OZ-CERTIFIED,WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KENNETH JORDAN
e. YIELD(gpm): 12 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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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 568. I Rev.3/07
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