GW1--04463_Well Construction - GW1_20230710

:Y, 1 1.L RESIDENTIAL WELL CONSTRUCTION RECORD
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f`3 n,t,,; 6 North Carolina Department of Environment and Natural Resources-Division of Water Quality
,'m"�,":Y. WELL CONTRACTOR CERTIFICATION# 3867 230055
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 117
RANDALL MAIN g. WATER ZONES(depth):
Well Contractor(Individual)Name From 440 To 442
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 0 To 110 Ft. F 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. 17 BAGS
WELL CONSTRUCTION PERMIT#389273 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 6/21/2023 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.
147 SUMMIT MEADOW LN OFF CHESTNUT RIDGE From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,lip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley II Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE — _ 36.14881 minutes,seconds or 0 105 DIRT,CONSOLIDATED ROCK
LONGITUDE 81.65525 in a decimal format 105 280 GRFY GRANITE
— — 280 360 LIMESTONE
Latitude/longitude source: ): GPS 0 Topographic map 360 400 GREY GRANITE
(location of well must be shown on a USGS topo map and 400 440 LIMESTONE
attached to this form if not using GPS) 440 442 VAIN .' ,.,—.. �.,,O"i:': �',17!
442 600 BLACK GRANITE 1. " 1•"''a :I .b 14' --S�
5,WELL OWNER
600 660 GREY GRANITE r ""'
OWNER'S NAME REBECCA STEELE J►Jt 1 0 ZQ23
STREET ADDRESS 1120 AHO RD "
r�ra
-BLOWING ROCK NC 28605
•City or Town State Zip Code
(828 )- 719-9897
Area code- Phone number 12. REMARKS:
1.25 GPM 440-442
6.WELL DETAILS:
a. TOTAL DEPTH: 660
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 .S BEEN PROVIDE THE WELL WNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface` i •073
*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): 1.25 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-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07

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