GW1-2021-04436_Well Construction - GW1_20210811

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
2780 k 210112
WELL CONTRACTOR CERTIFICATION# {(
1.WELL CONTRACTOR: f. DISINFECTION:Type i HTH Amount 73
KEITH PRESNELL. g. WATER ZONES(depth)
Well Contractor(Individual Name) From 240 To 241 From TO
DEVEY WRIGHT WELL&PUMP CO., INC. From TO From To
Well Contractor Company Name From To From To
STREET ADDRESS P.O.BOX 308 6.CASING: Thickness/
BOONE NC 28607 Depth Diameter Weight Material
From To Ft.
City or Town State Zip Code From To Ft.
( 828 )-264-2651 From TO Ft.
Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From To Ft.
SITE WELL ID#(f applicable) From To Ft.
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(f applicable) 359M &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply N From To Ft. in. in.
DATE DRILLED 7123/2021 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM® From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY: DRU-LDEBTR COUNTY waagm From To Ft.
315 SUNNY KNOLL ACRES OFF BAMBOO OFF HWY From _To Ft.
From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From TO Formation Description
(check appropriate box) 0 2010 EXITING WELL-.
May be in degrees,
LATITUDE 3 minutes,seconds or 200 240 GRANITE.
LONGITUDE in a decimal format 240 2It CRE\ACE-
Latitude/longitude source: LAGPS ❑Topographic map 9AJ 7W [:RANITE
(location of well must be shown on a USGS topo map and 280 MA QUARTZ
attached to this form if not using GPS) 283 300 BLUE GRANITE
4.WELL OWNER 300 385 GRANITEIGUARTZ
OWNER'S NAME WCAH 7TURNER 385 405 GRANITE
STREET ADDRESS315 SUNNY KNOLL ACRES,
BOONE NC 28607 0�:r P y
City or Town State Zip Code l
3( ( 17) )- 739-7254 AUG
1 �021
Area code-Phone number
5.WELL DETAILS: 11.REMARKS: (i•I CfI~a1bB prmess.Ing tl
a. TOTAL DEPTH: 405 4sCTRM 240-241 D1P4R Section
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOka Ljn'tt4 10J'e11 Ljk4A ♦ ! r=Uhta. {Iher*
c. WATER LEVEL Below Top of Casing: 40 FT. I DO HEREBY CERTIFY THAT THIS WELL-WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVID TO THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface* ^1
*Top of casing terminated at/or below land surface may require Q
a variance in accordance with 15A NCAC 2C.0118 IGNATURE OF CERTI I R DATE
e. YIELD(gpm): 4 METHOD OF TEST Air KFITI-1 PRFSNFI I.
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 568.1 Rev.7/05
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