GW1--04261_Well Construction - GW1_20230626

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• RESIDENTIAL WELL CONSTRUCTION RECORD
E`" o' North Carolina Department of-Environment and Natural Resources-Division of Water Quality
k --a-::::..,. WELL CONTRACTOR CERTIFICATION# 3867 230050
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 141
RANDALL MAIN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 90 To 92 From To
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 Il To 83 Ft. 6 1/8 350 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
From 0 To 20 Ft. BENTONIT GRAVITY
SITE WELL ID Cif applicable) From To Ft. 35-BAGS — —WELL CONSTRUCTION PERMIT#355163 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 6/14/2023 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: BLOWING ROCK COUNTY WATAUGA Depth . Size Material
From To Ft. s+,,.,. '^' r\fr 4,--
LOT#242 THUNDER HILL TRAIL OFF FIRETHORN' From To Ft. :�o ..`-''L`''' N. '--`,,
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. I I I N S! ^ ?f127
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other ,,.�, �, -
11. DRILLING LOG r^�" �r�
(check appropriate box) tn�v�t�`l" r-
May be in degrees, From To Formation Descripfi[3fY 'r�`D '
LATITUDE — — 36.14066N minutes,seconds or 0 79 DIRT,UNCONSOLIDATED ROCK
LONGITUDE 81.65094 in a decimal format 79 90 GRANITE
— — 90 92 VOID
Latitude/longitude source: X GPS 0 Topographic map 92 120 GRANITE
(location of well must be shown on a USGS topo map and 120 500 GREY GRANITE
attached to this form if not using GPS) 500 600 QUARTZ,GRANITE
5.WELL OWNER 600 800 GRANITE
OWNER'S NAME ROBERT MATTESON C/O FIRETHOR
STREET ADDRESS PO BOX 1769
BLOWING ROCK NC 28605
City or Town State Zip Code
(828 )_ 268-1618
Area code- Phone number 12. REMARKS:
5 GPM 90-92
6.WELL DETAILS:
a. TOTAL DEPTH: 800
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: 60 FT. RECORD "S BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) 1
d. TOP OF CASING IS 1 FT.Above Land Surface* �1�� �?y �O`3
*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):_ 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:Information Mgt., Form GW-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. 1 Rev.3/07

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