GW1-2022-02828_Well Construction - GW1_20220224

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REsiDBNTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR:KEITH PRESNELL If. DISINFECTION:Type HTH Amount 70
g. WATER ZONES(depth):
Well Contractor(Individual Name) From 192 To 209 From 365 To 370
DEVVEY WRIGHT VVELL &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 28607 Depth Diameter Weight Material
From 0 To 78 Ft. 61/8 .350 PVC
City or Town State Zip Code From To Ft.
( 8M )-2464-2651 From To Ft.
Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From 0 To 20 Ft:BENTONTT Gravity Flow
51TE WELL ID-#(if appiicabiej " From -""To Ft `Z2-BAG`J'"
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(f applicable) 276276 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply® From To Ft. in. in.
DATE DRILLED 2/9/2022 From To Ft. in. in.
TIME COMPLETED 0100 AM❑ PM BSI From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY.. BANNEa= COUNTY Wat = From To . Ft.
OFF CLARKS CREEK OFF HWY 105 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 69 DIRT
May be in degrees,
LATITUDE 3 36.17540 minutes,seconds or 69 192 - GRANITE
LONGITUDE _ -81.769619 in a decimal format 192 208 QUARTZ
Latitude/longitude source: IN GPS ❑Topographic map 208 277 GRANITE
(location of well must be shown on a USGS topo map and 277 290 SHALE
attached to this form if not using GPS) 290 365 GRANITE
4.WELL OWNER 365 370 QUARTZ
OWNER'S NAMEGREGORY FRiE,DHAIA 370 425
STREET ADDRESyo VPC BUILDERS 2059 TYNECASTLE `�0
BANNER= NC 28604
City or Town State Zip Code FEB 2 4 202?
((= _406-0290
Area code-Phone number9i {;(1(9!
5.WELL DETAILS: 11.REMARKS: 6'rax `' 1
a. TOTAL DEPTH: 425 2 GPM 192-2()8 28 GPM 365-370
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOX]
i
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 CONSTRUCTION STANDARDS,AND T T A COPY OF THIS
ADRDHA BEEN ROV 0 THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface'
Top of casing terminated at/or below land surface may require V p�
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 30 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 666. Rev.7/05
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