GW1--06665_Well Construction - GW1_20231006

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4.SrAre;y .,
't. r 4 RESIDENTIAL WELL CONSTRUCTION RECORD.
J / l=,_ -g," North Carolina Department of Environment and Natural Resources-Division of Water Quality
'"P.n°" ' WELL CONTRACTOR CERTIFICATION# 3867 ,230127
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1.WELL CONTRACTOR: f. DISINFECTION:Typal HTH Amount 98
RANDALL MAIN g. WATER ZONES(depth): -
Well Contractor(Individual)Name 'From 320 To 321
From 100 To 101 DEWEY WRIGHT WELL&PUMP CO., INC From 440 To 441:. From To
Well Contractor Company Name From To ' •- From To
STREET ADDRESS PO BOX 308 7. CASING: I • Thickness/
Depth I' Diameter Weight Material
BOONE NC 28607 From 0 To 61 Ft. 6 1/4 188 GALV
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
SITE WELL ID#(if applicable) From 0 To 20. . . Ft. BENTONIT _ GRAVITY
From To , Ft. 52 BAGS
WELL CONSTRUCTION PERMIT#394849 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.
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DATE DRILLED 9/12/2023 From To ' Ft. in., in.
TIME COMPLETED 0300 AM 0 PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: CRESTON COUNTY ASHE Depth Size Material
From To ' Ft. .;'" =-> - ,
331 JOINES RD OFF S. FLATWOODS RD OFF 88/6 From To I Ft. - x 4,...b" 4-' ' •
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.. - -
TOPOGRAPHIC/LAND SETTING: OD 0 U Z023
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other DRILLING LOG `
(check appropriate box) 11. In,-or7; ',n P!-.7,^1..;.i�, „
May be in degrees, From To • Formatiod3R� crip jc n .2 --
LATITUDE — _ minutes,seconds or 0 55 LIMESTONE,DIRT
LONGITUDE - in a decimal format 55 100 GREY.
GRANITE
— — 100 101 VAIN •
Latitude/longitude source: X GPS o Topographic map 101 320 GREYIGRANITE
(location of well must be shown on a USGS topo map and 320 - 321 VAIN 6 I
attached to this form if not using GPS) . 321 400 BLACK GRANITE •
5.WELL OWNER 400 440 GREY[GRANITE
440 441 VAIN I I
OWNER'S NAME BARBARA HAMPTON 441 500 BLACK GRANITE
STREET ADDRESS 331 JOINES RD ,
CRESTON NC 28615 -
City or Town State Zip Code - .
(423 )- 727-6407
Area code- Phone number 12. REMARKS:
1 GPM 100-101
6.WELL DETAILS: 1 GPM 320-321
a. TOTAL DEPTH: 500 .5 GPM 440-441 I I
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: 10 FT. RECORD S BEEN PROVIDED TO THErELL OWNER.
'(Use"+"if Above Top of Casing) `
d. TOP OF CASING IS 1 FT.Above Land Surface' / 1/1 I/ / 'ot-
*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): 1.6 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-la
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07

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