GW1-2021-03551_Well Construction - GW1_20210823

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.: RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
2780 Z00161
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 59
KEITH PRESNELL .
g. WATER ZONES(depth):,
Well Contractor Individual Name) From 257 To 258 From 311 T0312
DEVdEY MGHT 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 0 To 120 Ft. 61/8 .350 PVC
City or Town State Zip Code From To Ft.
( 8W ) 26 2651 From To Ft.
Area code-Phone number
7.GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20- FtBENTONTT &aoltYFlow
.
#(if appGcable-)— --- - - -- —---. _ -__ _- - — --__From -To ------Ft.
STATE WELL PERMIT#(if applicable) 10661 From To Ft.
DWQ or OTHER PERMIT#(if applicable) &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply 1 From To Ft. in. in.
DATE DRILLED 8/11/2021 From To Ft. in. in.
TIME COMPLETED AM ElPML.I'1� From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
SPRUCE PIN£ AVERY Depth Size Material
CITY: COUNTY From To Ft.
OFF TAYLOR MCFEE OFF LITTLE BUCK HELL RD O 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) 0 110 DIRT
LATITUDE 3 minutes,seconds or
N36+22.710 May in degrees, 100 257 GREY GRANITE
LONGITUDE -7UM*19.057 in a decimal format 257 258 CREVICE
Latitudeflongitude source: IN GPS ❑Topographic map 258 311 GREY GRANITE
(location of well must be shown on a USGS topo map and 311 312 QUARTZ/CREVICE
attached to this form if not using GPS) 312 325. GREY GRANITE
4.WELL OWNER ®ae l
I�I'EH BUCHANANIV
OWNER'S NAME �
STREET ADDRESSp O BOX 601 ,
SPRUCE PINE - NC 29M
City or Town State Zip Code 071111
(( 1.434-5268 to r
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 325 1 GPM 257-258 19 GPM 311 -312
b. DOES WELL REPLACE EXISTING WELL? YES❑ N0)0
c. WATER LEVEL Below Top of Casing: 30 FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUC STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BE NPR DED O T E WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface* !�J�" ��
*Top of casing terminated at/or below land surface may require 1 jaljj-of
a variance in accordance with 15A NCAC 2C.0118 SI OF ERTI IED O T DATE
i
e. YIELD(gpm): 20 METHOD OF TEST Air KEITH PRESNELL°
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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Submit the original to the Division of Water Quality within 30 days.Attn: Information Mgt., Form GW-1 a
1617 Mail Service Center- Raleigh,NC.27699-1617 Phone No.[phone] ext 568.j F Rev.7/05

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