GW1-2022-07113_Well Construction - GW1_20220801

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Ices-Division of Water Quality 220107
WELL CONTRACTOR CERTIFICATION# i
ir
1.WELL CONTRACTOR: f. DISINFECTION:Type Amount
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual Name) 135
❑EWEY VVRIGHT WELL &PUMF CO., INC. From To From To
From TO From To
Well Contractor Company Name
P.O.BOX 30$ From To From To
STREET ADDRESS 6.CASING: Thickness/
BOONE NC 286Ci7 Depth �$ Ft D6i�r ter SY 'ght aajerial
From O
City or Town State Zip Code
$2$ 2b4-2S51 From To Ft.
( )- From To Ft.
Area code-Phone number
7.GROUT: Depth f�I�
2.WELL INFORMATION: 0 20 EM'*6�T GravibM, d
oo
- -- _ From To- - Ft.-— —--
--- - _ _
22 B A, 0TS
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#fif applicable) f &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply6 From To Ft. in. in.
DATE DRILLED 7/&2022 yy��,, From To 'Ft. in. in.
TIME COMPLETED U '� AM❑ PM"!:.I From To Ft. in. IM
9.SAND/GRAVEL PACK: 1
&WELL LOCATION:
BOONE WatAMISI Depth Size AIJ er-'2022
CITY: COUNTY From7. TO Ft. 1
WE #10 TOWNHOMES AT BROOKSHIRE OFF`TO From _TO Ft.
ntom-fien Pro-casino
From _TO Ft. I /BOG
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley X1 Flat ❑Ridge ❑Other From TO Formation Description
(check appropriate box) 0 59 DIRT
May be in degrees,
LATITUDE 3 minutes,seconds or 69 132 i GRANITE
LONGITUDE in a decimal format 132 146 SHALE
Latitude/longitude source: 6 GPS ❑Topographic map 146 380 GRANITE
(location of well must be shown on a USGS topo map and 380 382 QUARTZ
attached to this form if not using GPS) 382 510 GRANITE
4.WELL OWNER 510 5W SHALE
OWNER'S NAME RCPBD INVESTMENTS LLC 530 531 QUARTZ
STREET ADDRESR,BOX 301$ -531 570- SHALE
$GONE NC 28607 570 700 GRANITE
City or Town State Zip Code
(( 8= )_262-3830
Area code-Phone number
5.WELL DETAILS: 11.REMARKS.
a. TOTAL DEPTH: 705 1.5 GPM 135-
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOU
c. WATER LEVEL Below Top of Casing: 60 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
ARECQRDAS BEEN PRO DED TO T ELL 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 " _ Q_LAW
SIGNATURE OF C TIFIED ViXf L CONTR T R DATE
e. YIELD(gpm): 1•5 METHOD OF TEST Ai KEITH PRESNELLI
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn:Informatio r Mgt., Form GW-1 a
1617 Mail Service Center-Raleigh, INC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

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