GW1-2022-02821_Well Construction - GW1_20220224

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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# 2790
1.WELL CONTRACTOR: I
KEITH PRESNELL f. DISINFECTION:Type HTH Amount 70
g. WATER ZONES(depth):;
Well Contractor(Individual Name) From 105 TO 110 From To
DEVVEY 1ARIGH T 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 22607 Depth Diameter Weight Material
From 0 To 30 Ft. 6118 350 PVC
City or Town State Zip Code From To Ft.
( 82S )-264-2651 From To Ft.
Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From0 To---2D- Ti1a Ft.R _0H Gravi Tncyw
SITE WELL ID#(if applicable) From To — FtI.I4RAC+C
STATE WELL PERMIT#(if applicable) From To Ft.
DWO or OTHER PERMIT#(if applicable) 166629 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 1/27/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM 10 From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY: BLOWING ROCK COUNTY WATAUGA From To Ft.
OLD ORCHARD RD OFF VALLEY VIEW OFF WOND From _To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From _To Ft.
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0 18 DIRT
May be in degrees,
LATITUDE 3 36.12488 N minutes,seconds or 18 105 GRANITE
LONGITUDE _ _ 81-69W W in a decimal format 105 110 01 IART7
Latitude/longitude source: W GPS ❑Topographic map 11n 97n rRANITE
(location of well must be shown on a USGS topo map and 2M 222 SHpI F
attached to this form if not using GPS) 7" un GRANITE
4.WELL OWNER 340 360 SHAI F
OWNER'S NAMERTCRART) T RWTR 360 425 GRANITE
STREET ADDRESS°fa PARADIGM CUSTOM HOME BUILDERS_ 15 - -- - � �1�/mn
BOONE NC 286t77
City or Town State Zip Code TEB 2 4-20V
((SM )-964-0048
Area code-Phone number
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5.WELL DETAILS: 11.REMARKS: Pnr cmrj I.ir�t'T
a. TOTAL DEPTH: 425 1 GPM 105 110
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO)IP
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c. WATER LEVEL Below Top of Casing: 80 FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUC N STANDARDS,AND THAT A COPY OF THIS
RE R HAS BEEr P VIDE O HE WELL 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 CONTRA TOR DATE
e. YIELD(gpm): 1 METHOD OF TEST Ai 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-1a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No. [phone] ext 568J Rev.7/05

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