GW1-2023-00588_Well Construction - GW1_20230109

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ESIDENTIAL WELL CONSTRUCTION RECORD
Water North Carolina Department of Environment and Natural Resources-Division of Quality
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WELL CONTRACTOR CERTIFICATION# 2780 1, 210096
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1.WELL CONTRACTOR: f. DISINFECTION:Type HT Amount 180
KEITH PRESNELL
g. WATER ZONES(depth)
Well Contractor(Individual)Name From 575 To 580 From 610 To 6.15
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
_a_Tom_Ft-6 1/R 2150 P\/(,
City or Town State Zip Code From To Ft.
8L 28 )-264-2651 From To Ft.
Area code- Phone number
2.WELL INFORMATION: 8. GROUT: Depth Material Method
SITE WELL ID#(fapplicable) From 0 To 20 Ft. BENTONIT GRAVITY
From To__ ,Ft. 18 BAGS__
WELL CONSTRUCTION-PERMIT#-138546- — - — — - -From To ift
OTHER ASSOCIATED PERMIT#(if applicable) 9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply 0 From To Ft. in. in.
DATE DRILLED I()-X�' From —TO—,Ft. in. in.
TIME COMPLETED03:00 AM PMflX 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)Q 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,
in a decimal format 34 210 GRANITE
LONGITUDE__ 210 265 SHALE
Latitude/longitude source:X GPS u 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 1^^I ® 9 20`•3
OWNERS NAME CLEMON BOYETTE 610 615 QUARTZ
615 700 GRANITE v :)7%•i
STREET ADDRESS 3404 GRAYLYN TERRACE
WILMINGTON NC 28411
City or Town State Zip Code
(9.10 )- 274-3040
Area code- Phone number 12. REMARKS:
5 GPM 575-580
6.WELL DETAILS: 7 GPM 610-615
a. TOTAL DEPTH: 700
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX 1 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 PROVIDED TO THE WELL OWNER.
(Use"+"if Above Top of Casing) ' I /1 - 'f
d. TOP CASING IS 1 FT.Above Land Surface �
'Topp of casing terminated atJor below land surface may require SIGNATURE OF CERTIFIEDWELL C6NTRA'CTOR DATE I
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL 1
e. YIELD(Spm): 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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