GW1-2023-00587_Well Construction - GW1_20230109

il
' .�c5TA1Ea'` D I
RESIDENTIAL WELL CONSTRUCTION RECORD
is Q North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2669 210238
i I
1.WELL CONTRACTOR: f. DISINFECTION:Type'HTH Amount 25
KENNETHJORDAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 55 To 60 From 110 To 115
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 Tom_Ft. R 1/8 1150 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-L-ID#(ifapplicable)- —--- - - - --- - _- From 0 To 20 Ft. BENTONIT GRAVITY
From To Ft. 27 BAGS
WELL CONSTRUCTION PERMIT#161020 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 12/22/2022 From—To—Ft.—In. in.
TIME COMPLETED 0300 AM O PM OX From—To—Ft.—in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: VILAS COUNTY WATAUGA Depth Size Material
From To Ft.
243 WILBURN ROMINGER OFF REECE RD OFF BE 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 — — 36.341561 minutes,seconds or 0 40 RED DIRT SHALE
LONGITUDE 81.816208 in a decimal format 40 55 GRANITE
— — 55 60 SHALE ROCK PINK SLATE
Latitude/longitude source: X GPS Il Topographic map 60 110 GRANITE
(location of well must be shown on a USGS topo map and 110 115 CREVIS ROCK BLACK SLATE BLACK WATER
attached to this form if not using GPS) 115 140 GRANITE
5.WELL OWNER I
OWNER'S NAME
IRENE WOODARD
STREET ADDRESS 243 WILBURN ROMINGER RD
VILAS NC 28692
City or Town State Zip Code ' fi .nv J
82( 8 )- 297-3378
Area code- Phone number 12. REMARKS: U-l
5 GPM 55-60
6.WELL DETAILS: 25 GPM 110-115
a. TOTAL DEPTH: 140
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 HA EEN PROVIDE THEjWELL OWNER.
(Use"+"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�IFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KENNETH JORDAN 1
e. YIELD(gpm): 30 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
i
Submit the original to the Division of Water Quality within 30 days. Attn:Information Mgt., Form GWAa
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. i Rev.3/07
r
� I

or rnst
40