GW1--05481_Well Construction - GW1_20230821

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-1RESIDENTIAL
WELL CONSTRUCTION RECORD
1' g North Carolina Department of Environment and Natural Resources-Division of Water Quality
:_�,,? WELL CONTRACTOR CERTIFICATION# 3867 220157
1
1.WELL CONTRACTOR: _ f. DISINFECTION:Type HTH Amount 54
RANDALL MAIN g. WATER ZONES(depth):
Well Contractor(Individual)Name • From 80 To 81 From 240 To 241
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 60 Ft. 6 1/4 . 188 GAI V
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. 26 BAGS
WELL CONSTRUCTION PERMIT#374301 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 8/9/2023 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: WEST JEFFERSON COUNTY ASHE Depth Size Material
From To Ft.
OFF IDLEWILD OFF 221 OFF 421 r From To Ft. .
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE —_ minutes,seconds or 0 55 DIRT
LONGITUDE in a decimal format 55 80 GREY GRANITE
— — 80 Si VAIN
Latitude/longitude source: X GPS 0 Topographic map 81 180 • GREY GRANITE
(location of well must be shown on a USGS topo map and 180 240 BLACK GRANITE
attached to this form if not using GPS) 240 241 VAIN
241 300 BLACK GRANITE
5.WELL OWNER �--J�.. }
OWNER'S NAME TOM TREXLER P R L,L,,I:i EL
--STREET ADDRESS 558 WHITE OAK RD - AUG 2 ,1 2023
BOONE NC 28607
City or Town State Zip Code ttA,f,a;aii n rr'f9 c41 Ur7i
( 828 )_ 266-3187 L WC./2{k;
Area code- Phone number 12. REMARKS:
3.3 GPM 80-81
6.WELL DETAILS: •
a. TOTAL DEPTH: 300
0.3 GPM 240-241
b. DOES WELL REPLACE EXISTING WELL? YES 11 NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUOTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 40 FT. RECORD HAS BEEN PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* ?4/a?
*Top of casing terminated at/or below land surface may require SIG ATURE OF CERTIFIED ELL CONTRACTOR DATE '
a variance in accordance With 15A NCAC 2C.0118. RANDALL MAIN
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e. YIELD(gpm): 3.6 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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Submit the original to the Division of Water Quality within 30 clays. Attn: Information Mgt., Form GW-la
1617 Mail.Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568. ' Rev.3/07

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