GW1--04270_Well Construction - GW1_20230626

•
.
srAre,
r ' 11r ," RESIDENTIAL WELL CONSTRUCTION RECORD
`� r / o '. North Carolina Department of Environment and Natural Resources-Division o Water Quality
yw,""` WELL CONTRACTOR CERTIFICATION# 3867 220,133
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 45 '
RANDALL MAIN 'g. WATER ZONES(depth): .
Well Contractor(Individual)Name
. From 120 To 121 From To
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 From 0 To 47 Ft. 6 1/8 350 PVC
City or Town State Zip Code - From To Ft.
(828 )-264-2651 From To Ft.
Area code- Phone number
(
2.WELL INFORMATION: 8. GROUT: Depth Material Method
SLTE_WELLID (fappficable) From 0 To 20 Ft. BENTONIT GRAVITY
From — To —Ft:22-BAGS — -- --
WELL CONSTRUCTION PERMIT#247584 From To Ft. •
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply 0 From To Ft. in. in.
DATE DRILLED 6/17/2023 From To Ft. in. in.
TIME COMPLETED 0300 AM II PM IX From To Ft. in. in.
4.WELL LOCATION: • 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA Depth Size M,a, ,rim n T,,
)L a off , S�•Q---. ,.y
From To Ft. .-�7._t �, ,�._i
OFF HIVIEW DR OFF MACK HAMPTON RD OFF 32 From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. JUN ?l'?3
TOPOGRAPHIC/LAND SETTING:
0 Slope II Valley 0 Flat 0 Ridge 0 Other s,-..,.s;. 'err.^.77:4 , t:rt
11. DRILLING LOG tn(.�1 r"';a....1 '
(check appropriate box) rte �t�: Oy
LATITUDE 36.15852 May be in degrees, From To Formation DescrIption
— — minutes,seconds or 0 36 DIRT,UNCONSOLIDATED ROCK
•
LONGITUDE 61.64064 in a decimal format 36 120 GRANITF
— — 120 121 GRANITE,SHALE
Latitude/longitude source: X GPS 0 Topographic map 121 160 SHALE .
(location of well must be shown on a USGS topo map and 160 220 GRANITE,QUARTZ
attached to this form if not using GPS) 220 300 GRANITE
5.WELL OWNER
OWNER'S NAME ERIC RABINOWITZ '
STREET ADDRESS 855 EAGLE DR
BOONE . NC 28607 - —.
City or Town State Zip Code
(828 )- 406-0601
Area code- Phone number • • 12. REMARKS:
• 4.5 GPM 120-121 .
6.WELL DETAILS:
a. TOTAL DEPTH: 300 •
1
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 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: 80 FT. RECOR 1AS BEEN ROVI E TO THE
EWWELL
�OWNER
. /�
(Use"+"if Above Top of Casing) ,, "��^' I �'b"�yp��
d. TOP OF CASING IS 1 FT.Above Land Surface* 1
`Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RANDALL MAIN
e. YIELD(gpm): 4.5 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 GW-1 a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07
I

•Foraftge
'743,b rc'
dee d
-
go2/ •
70.