GW1-2022-00342_Well Construction - GW1_20221222

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RESIDENTUL WELL CONSTRUCTION RECORD
g North Carolina Department of Environment and Natural Resources-Division of,Water Quality
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WELL CONTRACTOR CERTIFICATION# 2780 220050
1.WELL CONTRACTOR: f. DISINFECTION:Type,HTH Amount 114
KEITH PRESNELL g, WATER ZONES(depth):
Well Contractor(Individual)Name From 450 To 468' From 640 To 656
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
O_To 40 Ft._6 1/A 390 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
SITE WELL ID#(if applicable) From 0 To 20 Ft. BENTONIT GRAVITY
From - To -- FIt.-19-BAGS--
WELL CONSTRUCTION PERMIT#368151 - - - --From To Flt.
OTHER ASSOCIATED PERMIT#(if applicable) 9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply IX From To Ft. in. in.
DATE DRILLED 12/5/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA From To Ft.Depth Size Material
OFF JOHN DOTSON RD OFF POPLAR GROVE OR 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 X Ridge 0 Other
(check appropriate box) 11.DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE __ 36.18442 minutes,seconds or 0 8 DIRT
61.71881 in a decimal format 8 26 BROWN SHALE
LONGITUDE_ _ 26 238 GRANITE -
Latitude/longitude source: X GPS O Topographic map 238 00 SHALE
(location of well must be shown on a USGS topo map and 270 450 GRANITE
attached to this form if not using GPS) 450 468 GRANITE QUARTZ
468 510 GRANITE
5.WELL OWNER 510 538 SHALE I _
OWNER'S NAME JOHN GLENN 538 640 GRANITE
STREET ADDRESS PO BOX 1690 640 656 QUARTZ .
656 700 GRANITE - n 1 5 F5•U,, `
BLOWING ROCK NC 28605
City or Town State Zip Code L�2�
832 - 469-4524 •
Area code- Phone number 12. REMARKS:
3 GPM 450-468
6.WELL DETAILS-
a. GPM 640-656
a. TOTAL DEPTH: 700
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOI#C 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: 140 FT. RECORD HAS BEEN PROVI 0 THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface*
'Top of casing terminated atfor below land surface may require SIGNATURE O , RTIFIED WELL CO TRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 10 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.3107

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