GW1--05850_Well Construction - GW1_20230912

I
I
.
1
5Tok
try'y�j�' RESIDENTIAL WELL CONSTRUCTION RECORD
.,4 1`r g; North Carolina Department of Environment and Natural Resources-Division if Water Quality
f WELL CONTRACTOR CERTIFICATION# 3867 230041
i
1.WELL CONTRACTOR: f. DISINFECTION:Type!HTH Amount 46
RANDALL MAIN g. WATER ZONES(depth):'
Well Contractor(Individual)Name From 100 To 1021 From 200 To 210
DEWEY WRIGHT WELL&PUMP CO., INC From To From To
I
Well Contractor Company Name From To 1 From To
STREET ADDRESS PO BOX 308 - 7. CASING: Thickness/
Depth Diameter Weight Material
BOONE NC 28607 From 0 To SO ' 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
•
SITE WELL ID#(ifapplicable)_ From 0 To 20 Ft. BENTONIT GRAVITY
-
From_ To a Ft. 6 BAGS -
WELL CONSTRUCTION PERMIT#379990 From To I.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 8/28/2023 From _ To •'Ft. in. in.
TIME COMPLETED 0300 AM 0 PM OX From To Ft. in. in.
4.WELL LOCATION: - 10.SAND/GRAVEL PACK: ' 4
CITY: TODD COUNTY ASHE Depth Size Material
•
From To Ft.
OFF RAILROAD.GRADE RD OFF CASTLEFORD OF 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 I
(check appropriate box) 11.DRILLING LOG I
May be in degrees, From To ; Formation Description
LATITUDE — — 36.27944N minutes,seconds or 0 75 DIRT,iWATER
LONGITUDE 81.56993W in a decimal format 75 100 , GRANITE
— — 100 102 VAIN
Latitude/longitude source: X GPS 0 Topographic map 102 200 ' GRANITE C'y:- ...., ,.
(location of well must be shown on a USGS topo map and ' . 200 210 CREVIS 4 v ''
" jt
attached to this form if not using GPS) 210 240 GRANITE QUARTZ - •.✓
•, 5.WELL OWNER I I SEP p G 2023
OWNER'S NAME WALTER&PATRICIA FRANTZEN I I;
STREET ADDRESS PO BOX 25
TODD NC 28684 — —
City or Town State Zip Code
( 828 )- 406-2155 •
Area code- Phone number 12. REMARKS:
.9.5 GPM 100-102 .
6.WELL DETAILS: 4 GPM 200-21 O
a. TOTAL DEPTH: 240
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: 15. FT. RECOP HAS BEEN PROVIDED TO THE WELL WNER.
(Use"+"if Above Top of Casing) nS
d. TOP OF CASING IS 1 FT.Above Land Surface* g e3a-
*Top of casing terminated at/or below land surface may require SIGNATURE OF C TIFIED WEL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. RANDALL MAIN l
II
e. YIELD(gpm): 13.5 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL •
• i
` I
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. • Rev.3/07
I ,
i
.. I,
. •
I ,

y /
.
. ./ . ,
.
. 1 1
V i� I\
. . 1\.,,,.
`,
t-i' ::' . .
. . , ,:),3 .
1\\ .1
��,b Y � ,\el. ' 441 .. .
of N r
yv
� . J
I,
. bbl h�
I��
J �
7
...
� :_ . . ... ilitib,.