GW1-2022-09561_Well Construction - GW1_20221021

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. RESIDENTML WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
Q:,.
WELL CONTRACTOR CERTIFICATION# 2669 220065
1.WELL CONTRACTOR: f. DISINFECTION:Type FITH Amount 105
KENNETH JORDAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 355 To 357 From 712 To 717
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 0 To(30_Ft. R 118 350 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 To 20 Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) - - —From _ To--- Ft.26-BAGS" -WELL CONSTRUCTION PERMIT#362940 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply X From To Ft. in. in.
DATE DRILLED 10/13/2022 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: DRY HOLE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF JUNALUSKA/EASTVIEW/KING ST 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 — — 36.24757 minutes,seconds or 0 47 RED DIRT SHALE ROCK
LONGITUDE 81.71511W in a decimal format 47 355 GRANITE-WHITE QUARTZ
— — 355 357 GRANITE WHITE QUARTZ
Latitude/longitude source: o GPS li Topographic map 357 712 GRANITE
(location of well must be shown on a USGS topo map and 712 717 FLINT WHITE QUARTZ
attached to this form if not using GPS) 717 800 GRANITE
5.WELL OWNER
OWNER'S NAME PERRY PINSKE
STREET ADDRESS PO BOX 2771
BOONE NC 28607 20422
City or Town State Zip Code
828 773-9706 In;>r�a-a`a�� ar^"'=' r3 Una
Area code- Phone number 12. REMARKS:
6.WELL DETAILS: 25 GPM 355-357 .25 GPM 712-717
a. TOTAL DEPTH: 800
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 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: 300 FT. RECORDHS�PROVID 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 JSIGNATURECERTIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KENNE/I H JORDAN
e. YIELD(gpm): •5 METHOD OF TEST AIR PRINTED NAME OF
PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn ormation Mgt., Form GW-1a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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