GW1-2022-06391_Well Construction - GW1_20220603

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 E 210199-2
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 26
KEITH PRESNELL
g. WATER ZONES(depth):
Well Contractor(Individual Name) From as To 92 From i i n To ill
I=?CMv1I:--Y-VvWI(6H+ALL &HUMH UU., INii.
From 132 To 133 From To
Well Contractor Company Name From To From To
STREET ADDRESS P 0.80X 308 6.CASING: Thickness/
BOONE NC 28607 Depth Diameter Weight Material
From 0 To 60 Ft. 6I/8 .350 PVC
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 - F20 t
Cl:-- SITE WELL ID#(,f applicable) From To Ft.22 RAGS
STATE WELL PERMIT#(if applicable) From To Ft.
DWO or OTHER PERMIT#(if applicable) 184350 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 5/2412022 From TO Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM KI From To Ft. in. in.
9.SAND/GRAVEL PACK:
3.WELL LOCATION:
Depth Size Material
CITY: BANNER K COUNTY Watagua From To Ft.
LOT 8 OFF CRAB ORCHARD OFF TOM SHOOK RD O 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) n 5n DIRT
May be in degrees,
LATITUDE 3 161$9611 minutes,seconds or Fn 59 GRANIIE
LONGITUDE -81.704577 in a decimal format 89 92 QUARTZ
Latitude/longitude source: N GPS ❑Topographic map 92 tin GR ANITF
(location of well must be shown on a USGS topo map and i ifi Ill— V()In
attached to this form if not using GPS) ill 132 GRANITE
4.WELL OWNER 132 133 VOID
OWNER'S NAMESHP.NE PHM M 133 145 t--
STREET ADDRESSfoF'R.AZIER CONTRACTING 295 -
ELK PARK NC 28622
City or Town State Zip Code
(( 304) )_972-7452
Area code-Phone number �°�}'-K r K
5.WELL DETAILS: 11.REMARKS: ihii!U' I'Jam'
a. TOTAL DEPTH: 145 2 GPM 89-92 6 GPM 110- 111
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOSII 32 GPM 132-133
c. WATER LEVEL Below Top of Casing: 20 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 PROVIDE THE 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 O OR DATE
e. YIELD(gpm): 40 METHOD OF TEST Air K ITH PR SN Ik Cl
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 566. Rev.7/05

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