_Well Construction - GW1_20230315 (47)

:;,6.5ser5q c , RESIDENTIAL
RESIDENTIAL WELL CONSTRUCTION RECORD
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i 3 i ,A'',R North Carolina Department of Environment and Natural Resources-Division of Water Quality
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4,4 °. ' , WELL CONTRACTOR CERTIFICATION# 2780 220172
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 25
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 162 To 170 From 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/
Depth Diameter Weight Material
BOONE NC 28607 From f) To 138 Ft. 6 1/4 188 GAI V
City or Town State Zip Code From To Ft.
(828 )-264-2651 From To Ft.
Area code- Phone number
2.WELL INFORMATION: 8. GROUT: Depth Material Method
SITE WELL ID#(if applicatiie) From 0 To 20 Ft. BENTONIT GRAVITY
From To Ft. 25 BAGS
WELL CONSTRUCTION PERMIT#364732 From To Ft.
' OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply 1< From To Ft. in. in.
DATE DRILLED 2/28/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM IX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: ZIONVILLE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF OLD BURG LN OFF HWY 421N OFF HWY 105 From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
O Slope 0 Valley 0 Flat II Ridge 0 Other
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE _ _ 36.32311 N minutes,seconds or 0 120 MUD
LONGITUDE_ _ 81.73701 W in a decimal format 120 GRANITF
160 162 GRANITE
Latitude/longitude source: X GPS ii Topographic map 170 180 GRANITE
(location of well must be shown on a USGS topo map and - _
attached to this form if not using GPS)
5.WELL OWNER , I, ` . ..
OWNER'S NAME LARRY&PAM GREER MA(' li. ✓ G91:
STREET ADDRESS PO BOX 196
ZIONVILLE NC 28698
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City or Town State Zip Code
(828 )- 434-3849
Area code- Phone number 12. REMARKS:
40 GPM 162-170
6.WELL DETAILS:
a. TOTAL DEPTH: 180
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO 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: 60 FT. RECQRD HAS BEEN PRO IDED TOWELL OWNER. / 7��
(Use"+"if Above Top of Casing). �✓�'C�C -1 A66 3
d. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATUR OF CE TIFIED W ONT R DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 40 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-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.3/07

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