GW1-2023-02819_Well Construction - GW1_20230420

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I f r} 1,` ', RESIDENTIAL WELL CONSTRUCTION RECORD
• 3 . r el,"; North Carolina Department of Environment and Natural Resources-Division of Water Quality
. WELL CONTRACTOR CERTIFICATION# 2669 230046
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 69
KENNETH JORDAN g. WATER ZONES(depth):
Well Contractor(Individual)Name From• 170 To 200 From 370 To 371
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 RFi Ft. R 1/R 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
SITE WELL ID#(if applicable) — From-0--- -To 20- -Ft-BENTONIT-----GRAVITY -- - --
From To Ft. 20 BAGS
WELL CONSTRUCTION PERMIT#367294 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 4/11/2023 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: BOONE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF PINE HILL RD OFF POPLAR GROVE OFF HW` From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley X Flat 0 Ridge 0 Other 11.DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE — — 36.19165N minutes,seconds or 0 76 DIRT
LONGITUDE 81.72614W in a decimal format 76 170 GRANITF
— — - 170 200 GRANITE QUARTZ
Latitude/longitude source: )4 GPS 0 Topographic map 200 280 GRANITE
(location of well must be shown on a USGS topo map and 280 320 SHALE
attached to this form if not using GPS) 320 370 GRANITE
370 371 VOID
5.WELL OWNER 371 420 GRANITE
OWNER'S NAME MATT VINCENT/THOR BUILDERS
STREET ADDRESS 2059 TYNECASTLE HWY " '
BANNER ELK NC 28604 n nn 2 tl4O73
City or Town State Zip Code
(828 )_ 266-3009 l;f,i3;,�:m: si :, , _ .....J
Area code- Phone number 12. REMARKS: D'°'",
2 GPM 170-200
6.WELL DETAILS: 10 GPM 370 371
a. TOTAL DEPTH: 420
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. RECORD HAS EEN PR ED TO HE WE OWNER.
(Use"+"if Above Top of Casing) � � y
d. TOP OF CASING IS 1 FT.Above Land Surface* // v2.
'Top of casing terminated at/or below land surface may require SIGNATURE OF TIFIED WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KENNETH JORDAN -
e. YIELD(gpm): 12 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1
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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 568.1 I Rev.3/07

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