GW1-2021-00278_Well Construction - GW1_20211213

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.: RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 210223
1.WELL CONTRACTOR: } f
KEITH PRESNELL f. DISINFECTION:Type i HTH Amount 43
g. WATER ZONES(depth):
Well Contractor(Individual Name) From 250.To 252 From To
DEWEY VYh2iGH T YVELL &PUMP CO., IN(_;. From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P.O.BOX 308 6.CASING: Thickness/
BOONE NC 286O? Depth Diameter Weight Material
From 0 Tom Ft. 61/8 .350 FTC
City or Town State Zip Code From To Ft.
( 828 )-264-2651 From To Ft.
Area code-Phone number
7.GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To 20 FIt.BENTONIT Gravity Flow
SITE WELL ID#(if applicable) From To Ft.18$AZr8
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) VTP668 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply CA From To Ft. in. in.
DATE DRILLED I1/N4/2021 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM gl From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY: L'ENOIR COUNTY CALDVT ML From To Ft.
4749 WHICESBORO BLVD OFF WILIGSBORO BLVD 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 72 DIRT
_ 36.024621 May o in degrees,
LATITUDE 3 minutes,seconds or 72 160 GRANITE
LONGITUDE in a decimal format 160 163 QUARTZ
Latitude/longitude source: ®GPS ❑Topographic map 163 230 GRANITE
(location of well must be shown on a USGS topo map and 230 238 SHALE
attached to this form if not using GPS) 238 250 - GRANITE
4.WELL OWNER 250 252 QUARTZfVOID
OWNER'S NAMEBOBBY&CARRIE GRAGG 252 265 GRANITE
STREET ADDRESSI031 FLAT SPRINGS RD. _ -
ELI{PARX NC 28622 -
City or Town State Zip Code
�(82c';� 963-0536 Off 3
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 265 50 GPM 250-252
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOX,I
c. WATER LEVEL Below Top of Casing: 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 B EN PROVIVP TO THE!WELL OWNER.
%d. TOP OF CASING IS 1 FT.Above Land Surface' L
Top of casing terminated at/or below land surface may require l 7
a variance in accordance with 15A NCAC 2C.0118 SIGN TUBE O CERTIFIED WELL CON RACTOR DATE
e. YIELD(gpm): 50 METHOD OF TEST Air KEITH PRESNELL
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
1
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 56 Rev.7/05
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