GW1-2022-09212_Well Construction - GW1_20220930

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.: RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 27R0 220042
1.WEL1L CONTRACTOR: f. DISINFECTION:Type 'H I H Amount 114
IElTH PRESNELL g, WATER ZONES(depth):
Well Contractor(Individual Name) From 200 To From To
DEWEY WRIGHT WELL&PUMP CO., INC.
From To From TO
Well Contractor Company Name From To From To
STREET ADDRESS P. G.T,Ot,s:308 - 6.CASING: Thickness/
BOONE NC 2$6Cf7 Depth Diameter Weight Material
From 0 TO__RL_ Ft. d I/R _3 30 _— MR'
City or Town. State Zip Code From To Ft.
( 828 )264-2651 From To Ft.
Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth i Material Method
From y_To�0 FtR .TQATrT -witttr_Flm
SITE WELL ID#(if applicable) From To Ft.22 BA_
STATE WELL PERMIT#(if applicable) From To Ft.
DWO or OTHER PERMIT#(if applicable) &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply{] From To Ft. in. in.
DATE DRILLED W15j242,2 From To Ft. in. in.
TIME COMPLETED 01-00 AM❑ PM)i] From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY:DEEP GAP COUNTY WATAUGA From _To rFt.
S°TARDANCE TRAIL OFF BRIGHTWOOD RD OFF W From To Ft.
From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
0 Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box)
May be in degrees, r5 7(� L�1pT
LATITUDE 3 _ 361 QfY7W minutes,seconds or 70 730 r__p-AhlITF_
LONGITUDE _ _ —81 541 SC T in a decimal format 230 280 SH 61 E
Latitude/longitude source: W GPS ❑Topographic map 2500 4685 r_p anlf.Ti=
(location of well must be shown on a USGS topo map and _4N 49-2 p BpI IT�_tlI 16_pT;M1)
attached to this form if not using GPS)
402 605 R9AIITG
4.WELL OWNER 6415 Su e1 G
OWNER'S NAMEj,4b.Ry T1 xCL1.MC 11E-nT T E_9aMU T a .
8m o :(
..
- STREETADDRESSSe TR IGNEc CCINI STRUCTKN. 95 R_
i
City or own State Zip R-600611
Area code-Phone number +•s=51`1'Q ry 'j Ir.1
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ N00
C. WATER LEVEL Below Top of Casing: i A0 FT. 1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTA STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN P O IDED TY5 T E WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface'Top of casing terminated at/or below land surface may require VoLl-77 Q / Q
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CEVWFIED WELL CONTRACTOR DATE
e. YIELD(gpm): 1 METHOD OF TEST Air KEIMH PRESINIMiI
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, NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

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