GW1-2021-07769_Well Construction - GW1_20211116

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
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WELL CONTRACTOR CERTIFICATION# 2780 f 210091
1.WELL CONTRACTOR: HTH
KEITH PRESNELL f. DISINFECTION:Type Amount 30
g. WATER ZONES(depth):.
Well Contractor(Individual Name) From 171 To 172 From To
D VVEir*WRIGHT VVELL &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 60 Ft. 61/8 .350 PVC
City or Town State Zip Code From To Ft.
( 8M ).264-2651 From To Ft.
Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From 0 To 20 Ft.BE14TON7 Gravity Flaw
SITE WELL ID#(it applicable) From To Ft.
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 354M &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 10/29/2021 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM From To Ft. in. in.
9.SAND/GRAVEL PACK:
3.WELL LOCATION:
Depth Size Material
CITY: BOONE COUNTY wategua From To Ft.
OFF MTN FARM RD OFF HOWARDS CR=OFF TA 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 55 DIRT
May be in degrees,
LATITUDE 3 36.276611 minutes,seconds or 55 171 BLUE GRANITE
LONGITUDE -81.724811 in a decimal format 171 172 1 CREVICE
Latitude/longitude source: 09 GPS ❑Topographic map 172 205 BLUE GRANITE
(location of well must be shown on a USGS topo map and
attached to this form if not using GPS)
4.WELL OWNER
OWNER'S NAMEBnL RAGAN
STREET ADDRESSI86 RAGAN CULLER R.D. __► OV 1 R 9(1�1r
BOONE NC 286M
City or Town State Zip Code PANR
(( 828) )-297-4264 ��p�l vRnrI;MNG
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 205 10 GPM 171 -172
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO)tJ
c. WATER LEVEL Below Top of Casing: 60 FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUC ON STANDARDS,AND THAT A COPY OF THIS
RE ORD HASdJrFFERTIIF!IED
IDE THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface' P117'd'V '1 IL
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118 GNATURE C WELL CON OR DATE
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e. YIELD(gpm): 10 METHOD OF TEST Air KEITH PRESNELL�
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn:Information`Mgt., Form GW-1 a
1617 Mail Service Center- Raleigh,INC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

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