GW1--04264_Well Construction - GW1_20230626

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'` ''P _ "Es: RESIDENTIAL WELL CONSTRUCTION RECORD
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3 . ; ,g i North Carolina Department of Environment and Natural Resources-Division of Water Quality
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,., :,,,,...v.,, WELL CONTRACTOR CERTIFICATION# 3867 220220
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1.WELL CONTRACTOR: • f. DISINFECTION:Type HTH Amount 115
RANDALL MAIN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 73 To 400 From 400 To 600
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 t1 To 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_ (if applicable)_ From To Ft. 35 BAGS
WELL CONSTRUCTION PERMIT#290644 From To• Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply 13 From To Ft. in. in.
DATE DRILLED 6/8/2023 From To Ft.. in. _ _ in.
TIME COMPLETED 0300 AM II PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BLOWING ROCK COUNTY WATAUGA Depth Size Potaten IA T_;> 1 ';'"j
From To Ft. `„ ._. „a L ba..,:...
939 OLD STILLHOUSE OFF BLACKBERRY RD OFF From To Ft. JUN )n
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft. J V N 2, 5 2023
TOPOGRAPHIC/LAND SETTING:
X Slope 0 Valley 0 Flat Ridge 0 Other In;Cr' *y%�'1 3rr`"' "''g Ur;';
(check appropriate box) 11. DRILLING LOG DWO O'G
May be in degrees, From To Formation Description
LATITUDE — — 36.12468N minutes,seconds or 0 60 DIRT '
LONGITUDE 81.64270W in a decimal format 60 72 CONSOLIDATED GRANITE
— — 72 400 GREY GRANITE
Latitude/longitude source: X GPS ti Topographic map 400 600 BLACK GRANITE
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
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5.WELL OWNER ' i
OWNER'S NAME JAMES GARRETT C/O TIMBER STRU
STREET ADDRESS PO BOX 1597
BOONE NC 28607 —• —
City or Town State Zip Code
(828 ).. 964-0118
Area code- Phone number 12. REMARKS:
1 GPM 73-400
' 6.WELL DETAILS: 1 GPM 400 600
a. TOTAL DEPTH: 600
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX 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: 30 FT. RECORD S BEEN P VI - 0 THE WELL OWAIER.
(Use"+"if Above Top of Casing) �'/�-�
d. TOP OF CASING IS 1 FT.Above Land Surface* /1141. 1
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*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): 2 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
440.4, >146:,:
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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