GW1-2023-00884_Well Construction - GW1_20230118

RESIDENTIAL WELL CONSTRUCTION RECORD RECE� �'' r a J'r
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North Carolina Department of Environment and Natural Resources-Division of Water Quality JA N
RT�, 1 8 2023
WELL CONTRACTOR CERTIFICATION# 2780 230002
1.WELL CONTRACTOR: �k' n«
f. DISINFECTION:Type HTH Amouttf '�wJix
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 0 To 300 From 530 To 545
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 0 To Ft.
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 To Ft.
--- — --- --- From-- ---- -To._ Ft.- - - - - — —
WELL CONSTRUCTION PERMIT# 134038 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply X From To Ft. in. in.
DATE DRILLED 1/12/2023 From. To Ft. in. in.
TIME COMPLETED-03:00 AMU PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: DRILL DEEPER COUNTY WATAUGA From To Ft.Depth Size Material
221 CANE OFF GREENBRIAR OFF BAMBOO OFF 1 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 11.DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE _ — 36.21472N minutes,seconds or 0 300 EXISTING
LONGITUDE 81.62608W in a decimal format 300 380 GRANITE
— — 380 400 GRANITE QUARTZ
Latitude/longitude source: X GPS 0 Topographic map 400 530 GRANITE
(location of well must be shown on a USGS topo map and 530 545 QUARTZ
attached to this form if not using GPS) 545 605 GRANITE
5.WELL OWNER
OWNER'S NAME DONALD MORRISON C/O HIDDEN Cl
STREET ADDRESS 1950 BLOWING ROCK RD
BOONE NC 28607
City or Town State Zip Code
8( 28 )- 266-8628
Area code- Phone number 12. REMARKS:
2.5 GPM 0-300
6.WELL DETAILS: 2.5 GPM 530-545
a. TOTAL DEPTH: 605
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 CONSTRUCTIOVS NDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 80 FT. RE HAS BEEN PRO ED TO ELL 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 CE TIFIED WELL CONTRA DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 5 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,INC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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