GW1-2022-09127_Well Construction - GW1_20220930

RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2669 ! 220056
1.WELL CONTRACTOR: f. DISINFECTION:Type:HTH Amount 111
KENNETH JORDAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 150 To 157 From 515 To 521
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 To 11.5 Ft. 6 1/9 350 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
From_0_.—.To20 ..!__Ft.-BENTONIT GRAVITY
SITE WELL ID#(if applicable) From To Ft. 18 BAGS
WELL CONSTRUCTION PERMIT#364364 From To 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 09/19/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AMU PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: FLEETWOOD COUNTY ASHE Depth Size Material
From To Ft.
LOT 14 OFF OLDE FIELDS OFF BIG FLATTS CHU 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
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE _ — 36.31696N minutes,seconds or 0 30 RED SLATE/DIRT/CLAY
LONGITUDE 81.52732W in a decimal format 30 95 BROWN SAND/BROWN SLATE
— — 95 150 GRANITE i
Latitude/longitude source: XI GPS o Topographic map 150 157 BROWN SHALE/GRANITE/WHITE QUARTZ
(location of well must be shown on a USGS topo map and 157 515 GRAY-BLUE GRANITE/WHITES QUARTZ
attached to this form if not using GPS) 515 521 WHITE QUARTZ/GREEN GRANITE
6.WELL OWNER 521 660 GRANITE
CASH CUSTOM HOMES
OWNER'S NAME �..� � '� '• � �u
STREET ADDRESS 870 NC HWY 105 BYPASS V
BOONE NC 28607 — 03
City or Town State Zip Code Inge t .
( 828 )_ 773-4889 a�v r
�`L�3'�t?C,
Area code- Phone number 12. REMARKS:
4 GPM 150- 157
6.WELL DETAILS:
a. TOTAL DEPTH: 660 2 GPM 515-521
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOR 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: 120 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface"
*Top of casing terminated attor below land surface may require SIGNAT ERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KENNETH JORDAN
e. YIELD(gpm): 6 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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.. Rev.3/07

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