GW1-2022-01420_Well Construction - GW1_20220124

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RESIDENTIAL WELL CONSTRUCTION RECORD
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North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# I 21019i6
1.WELL CONTRACTOR:
KEITH PRESNELL f. DISINFECTION:Type HTH Amount 53
g. WATER ZONES(depth):
Well Contractor(Individual Name) From - 77 To 7 91 From 259 To 259
DEVVEY 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 0 To 57 Ft. 61/8 .350 PVC
City or Town State Zip Code From To Ft.
( M8 ).264-2651 From To Ft.
Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From 0 To 20 Ft.BENTONIT Gravity Flaw
WELL_ID#(if applicable)_ From To Ft.20BAGS _
STATE WELL PERMIT#(if applicable) From To R.
DWO or OTHER PERMIT#(if applicable) 364085 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 12122/2021 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PMXJ From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY: BOONE COUNTY W== From To Ft.
WELL#6 TOWNHOMM AT BROOKSHIRE OFF BRO 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 50 DIRT
May be in degrees,
LATITUDE 3 minutes,seconds or `o 77 GRAY GRANITE .
LONGITUDE in a decimal format 77 78 CREVICE
Latitude/longitude source: 8 GPS ❑Topographic map 78 258 GRAY GRANITE
(location of well must be shown on a USGS topo map and 258 259 CREVICE
attached to this form if not using GPS) 259 WS GRAY/BLUE GRANITE
4.WELL OWNER
OWNER'S NAME RCPBD INVESTM1TTS,L;LC
STREET ADDRE00 BOX 3018.
BOCNE NC 28607_
City or Town State Zip Code
(� 265-6344 fA��—=
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 305 8 GPM 77-78 2 GPM 258 259
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOX7
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c. WATER LEVEL Below Top of Casing: 50 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 PROVIDED TO THE'WEL L OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface"
Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
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,NC 27699-1617 Phone No.[phone] ext 56!.I Rev.7/05

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