GW1--05023_Well Construction - GW1_20230807

5rAT
. i ��' RE',SIDENT'IAL WELL CONSTRUCTION RECORD
`� , . ��p North Carolina Department of Environment and Natural Resources-Division of Water Quality
x" ` WELL CONTRACTOR CERTIFICATION# 3867 220191
1.WELL CONTRACTOR: • f. DISINFECTION:Type HTH Amount 72
RANDALL MAIN
g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 65 To 67 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 56 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 1 Ft. 18 BAGS — -
WELL CONSTRUCTION PERMIT#375441 From To Ft.
OTHER ASSOCIATED PERMIT#Of applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply I) From To Ft. in. in.
DATE DRILLED 7/19/2023 From To Ft. in. in.
TIME COMPLETED 0300 AM D PM DX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF FAIRVIEW HGTS OFF NC NORRIS OFF BRIAF From To Ft.
•
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
II Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE — — 36.29632N minutes,seconds or 0 50 UNCONSOLIDATED GRANITE
LONGITUDE 81.63305W in a decimal format 50 65 GRANITF
— — 65 67 VOID
Latitude/longitude source: X GPS 0 Topographic map 67 180 GREY GRANITE
(location of well must be shown on a USGS topo map and 180 220 GRANITE,QUARTZ
attached to this form if not using GPS) 220 400 BLACK GRANITE
5.WELL OWNER
OWNER'S NAME GREGORY& CHRISTINE CIANY C/O
STREET ADDRESS PO BOX 134 S E—• F q
WEST JEFFERSO NC 28694 ' Z""'f"'�L. t� `"T
City or Town State Zip Code AUG 0 7 20Z3
( 336 )- 877-7735
Area code- Phone number 12. REMARKS: ln;r i. n Pi -,.: Ur'A
2 GPM 65-67 D1'aW:Y3G
6.WELL DETAILS:
a. TOTAL DEPTH: 400
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO PC 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: 40 FT. RECOR,AS BEEN PROVID•.0 TO THE WELL OWIR.
* (Use"+"if Above Top of Casing) / / ),„4/144,...,
VA-13
d. TOP OF CASING IS 1 FT.Above Land Surface*Top of casing terminated at/or below land surface may require SI NATURE OF C RTIFIED WELL CONTRACTOR ATE
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
•
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

i
•
•
.. /
t/qy
/ •
7...........................--):‘,..........) ,C,V„
•
•
•
•
•
•
•
v •
•
..
',•
•
``�cr z
_ ' Fel;*v;ud; Ne%fthis