GW1-2022-09948_Well Construction - GW1_20221031

RESIDENTIAL WELL CONSTRUCTION RECORD
g- North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 ! 210096
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 180
KEITH PRESNELL
g. WATER ZONES(depth)!:
Well Contractor(Individual)Name From 575 To 580 From 610 To 615
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/
Depth Diameter Weight Material
BOONE NC 28607 From(_To 42 Ft. 6 1/8 3517) PVC
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 0 To 20 'Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) i _
- - From To Ft. 18 BAGS —`
WELL CONSTRUCTION PERMIT#138546 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply U From To Ft. in. in.
DATE DRILLED From To 'Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM DX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF FIRETOWER OFF EAGLE ROOST RUN OFF R From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley X Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From TO Formation Description
LATITUDE minutes,seconds or 0 34 DIRT
LONGITUDE in a decimal format 34 210 C;RANITE
— — 210 265 SHALE
Latitude/longitude source: X GPS o Topographic map 265 390 GRANITE
(location of well must be shown on a USGS topo map and 390 430 SHALE
attached to this form if not using GPS) 430 575 GRANITE
575 580 QUARTZ' ; ,- .
5.WELL OWNER 580 610 GRANITE F L—�o
OWNER'S NAME CLEMON BOYETTE 610 615 QUARTZ
STREET ADDRESS 3404 GRAYLYN TERRACE 615 700 GRANITE T 4 �i
WILMINGTON NC 28411
City or Town State Zip Code v
(910 )- 274-3040
Area code- Phone number 12. REMARKS:
5 GPM 575-580
6.WELL DETAILS: 7 GPM 610-615
a. TOTAL DEPTH: 700
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b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCTION!STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 180 FT. RECORD HAS BEEN PROVIW TO THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface- o�
'Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED WELL C TRA TOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
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e. YIELD(gpm): 12 METHOD OF TEST AIR PRINTED NAME OF PERSON,'CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:information Mgt., Form GW-1a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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