GW1-2022-03847_Well Construction - GW1_20220331

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of WI ter Quality
WELL CONTRACTOR CERTIFICATION# 2790 210106
1.WELL CONTRACTOR:
KEITH PRESNELL f. DISINFECTION:Type HTH Amount 46
g. WATER ZONES(depth):
Well Contractor(Individual Name) From 205 To 210 From 280 To 292
DEWIEY 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 120 Ft. 61/8 .350 PVC
City or Town State Zip Code From To Ft.
( 828 )-2&-2651 From To Ft.
Area code-Phone number
7.GROUT: Depth Material Method
2.WELL INFORMATION:
From 0 To20 Ft.EENTONIT Gravity Flow
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 763626 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply® From To Ft. in. in.
DATE DRILLED 3/8/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM 11.9 From To Ft. in. in.
9.SAND/GRAVEL PACK:
3.WELL LOCATION:
Depth Size Material
CITY: BANNER ELK COUNTY AVERY From To Ft.
LOT 39 OFF WHITE FOX LN OFF SILVER SPRINGS D 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) 0 111- DIRT
May be in degrees,
LATITUDE 3 _ 36.16i5937 minutes,seconds or ill 205 GRANITE
LONGITUDE -81.W2255 in a decimal format 205 210 QUARTZ
Latitude/longitude source: (X GPS ❑Topographic map 210 280 GRANITE
(location of well must be shown on a USGS topo map and 280 282 . VGIn
attached to this form if not using GPS) 282 305 GRANITF
4.WELL OWNER
OWNER'S NAMEIOHN MM J JAMS.
- - -STREET ADDRESS'/o VONCO-CONSTRUCTION. 198 BUCK C E -
BANNIER EIA NC 28604 I-
City or Town State Zip Code
387-7310 MAR 1 ?R9�
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 305 2 GPM 205-210 28 GFM',280 282 ?i l
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOXI
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 STAND49PS,AND THAT A COPY OF THIS
R D Hi S BEEN P O THE WE O NER.
d. TOP OF CASING IS 1 FT.Above Land Surface' )O�` —P ojvj,//,
Top of casing terminated at/or below land surface may require lz�i3.2,
a variance in accordance with 15A NCAC 2C.0118 NATURE OF CERTIFIED`WE L CON TOR IlAt
e. YIELD(gpm): 30 METHOD OF TEST Air KPITH PRFPNFI 11 1.
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
I :
Submit the original to the Division of Water Quality within 30 days.Attn:Information,Mgt., Form GW-1a
1617 Mail Service Center-Raleigh,INC 27699-1617 Phone No.[phone] ext 568. Rev.7/05
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