GW1-2022-09216_Well Construction - GW1_20220930

CTION RECORD
RESIDENTIAL WELL CONSTRU
North Carolina Department of Environment and Natural Resources-Division of Water Quality
4`*4 WELL CONTRACTOR CERTIFICATION# 2780 210181
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 128
KEITH PRESNELL g. WATER ZONES(deptF):
Well Contractor(Individual)Name From 0 To 284 From 660 To
DEWEY WRIGHT WELL& PUMP CO., INC From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 308 7. CASING: Thickness/
BOONE NC 28607 Depth Diameter Weight Material
From To Fin Ft. 6 1/4 IRS GALV
City or Town State Zip Code From To Ft.
8( 28 )-264-2651 From To Ft.
Area code- Phone number
2.WELL INFORMATION: 8. GROUT: Depth Material Method
--- — — -- From To- Ft.----
SITE WELL ID#(if applicable)
From To Ft.
WELL CONSTRUCTION PERMIT#361861 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply Ik From To Ft. in. in.
DATE DRILLED 09/16/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM O PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: DRILL DEEPER COUNTY WATAUGA Depth Size Material
From To Ft.
181 CAMERON TERRACE OFF TIMBERLANE DR From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From-To-- Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley 0 Flat 0 Ridge 0 Other
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE _ _ 36.239469 minutes,seconds or 0 284 EXISTING WELL
81.660248 in a decimal format 284 470 GRANITE
LONGITUDE_ _ 470 492 SHALE
Latitude/longitude source: A GPS 0 Topographic map 492 530 GRANITE-QUARTZ MIX
(location.of well must be shown on a USGS topo map and 530 648 GRANITE
attached to this form if not using GPS) 648 670 GRANITE-QUARTZ MIX
5.WELL OWNER 670 705 GRANITE
OWNER'S NAME DIANE KRADEL
STREET ADDRESS 340_NORTH ACADEMY ST
MOOREVILLE NC 28115 - ` " 2022.
City or Town State Zip Code U
( 704 )_ 657-1735
Area code- Phone number 12. REMARKS:
1.5GPM 0-284 1.5 GPM 660
6.WELL DETAILS: 60 FT OF CASING WAS EXISTING
a. TOTAL DEPTH: 705
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 0 I DO HEREBY CERTIFY THAT THIS,WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCTION ST ARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 50 FT. REC D AS BEEN R IDE O THE EL OWNER.
(Use"+"if Above Top of Casing) �-
d. TOP OF CASING IS 1 FT.Above Land Surface'
"Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL CONTRACTO DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 3 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
I
i
Submit the original to the Division of Water Quality within 30 days. Attn:Informalbon Mgt., Form GW-1a
1617 Mail Service Center-Raleigh, NC 27699-1617 Phone No. [phone] ext 568.E Rev.3/07

I
i
,cob
� ash
r
f
l