GW1-2023-01815_Well Construction - GW1_20230223

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„a srAtt,"
r , cl `�.< , RESIDENTIAL WELL CONSTRUCTION RECORD
y / �? North Carolina Department of Environment and Natural Resources-Division of Water Quality
- 4...„ ' , WELL CONTRACTOR CERTIFICATION# 2669 220170 .
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount .63 _
• KENNETH JORDAN g. WATER ZONES(depth):
• Well Contractor(Individual)Name From 240 To 243 From 380 To 385
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 107 Ft. fi 1/4 188 GA! V
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. 25 BAGS
WELL CONSTRUCTION PERMIT#356171 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)_
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply ID( From To Ft. in. in.
DATE DRILLED 2/7/2023 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: BANNER ELK COUNTY WATAUGA Depth Size Material
From To Ft.
LARKSPUR TRAIL OFF JUSTUS OFF CLARKS CRE 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 — _ 36.17222N minutes,seconds or 0 85 DIRT
LONGITUDE 81.78771 W in a decimal format 85 240 GRANITE
— — —— 240 243 GRANITE QUARTZ
Latitude/longitude source: X GPS o Topographic map 243 380 GRANITE
(location of well must be shown on a USGS topo map and 380 385 GRANITE QUARTZ
attached to this form if not using GPS) 385 400 GRANITE
5.WELL OWNER [,,,,,
OWNER'S NAME DAVID TURNER C/O CASH CUSTOM ; ,' -r, "" - -- -"'
STREET ADDRESS 870 NC HWY 105 BYPASS 7:Fa LOLJ
BOONE NC 28607
City or Town State Zip Code -- lif - ---'gin ''r� Ii
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(828 )_ 773-4889 `^''
Area code- Phone number 12. REMARKS:
1 GPM 240-243
6.WELL DETAILS: 49 GPM 380-385
a. TOTAL DEPTH: 400
b. DOES WELL REPLACE EXISTING WELL? YES a NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WI"rH
15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 100 FT. RECORD HAS BEEN P OVIDED TO THE WELL 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 IFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KENNETH JORDAN
e. YIELD(gpm): 50 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. 1 Rev.3/07

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