GW1-2023-01805_Well Construction - GW1_20230223

1 STRTE.....♦
s y ._ ,.. RESIDENTIAL WELL CONSTRUCTION RECORD
3 ?" g North Carolina Department of Environment and Natural Resources-Division of Water Quality
� 'tea+�,
'0„,.. ,, WELL CONTRACTOR CERTIFICATION# 2780 230012 .
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 74
KEITH PRESNELL
g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 180 To 190 From 360 To 370
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 11 To 55 Ft. R 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#(itapplicable) From 0 To 20 Ft. BENTONIT GRAVITY
From U To 6U Ft. CEMENT PUMPED
WELL CONSTRUCTION PERMIT#388761 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 2/7/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM IIX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA Depth Size Material
From To Ft.
1756 US HWY 421 OFF HWY 105 BYPASS 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 — — 36.22263N minutes,seconds or 0 36 DIRT
LONGITUDE 81.70253W in a decimal format 36 180 GRANITE
— — 180 190 QUARTZ
Latitude/longitude source: X GPS o Topographic map 190 270 GRANITE
(location of well must be shown on a USGS topo map and 270 290 GRANITE QUARTZ
attached to this form if not using GPS) 290 360 GRANITE
360 370 QUARTZ
5.WELL OWNER 370 405 GRANITE -
T
OWNER'S NAME BOB LEE
STREET ADDRESS 234 HOWARDS CREEK CHURCH R FEB Z023
BOONE NC 28607
City or Town State Zip Code
(828 )- 773-0497 Ir= <7vc` ,,J J. `0 Una
v
Area code- Phone number 12. REMARKS:
3 GPM 180-190
6.WELL DETAILS: 9 GPM 360-370
a. TOTAL DEPTH: 405 0-60 LINER PIPE
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO DC 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: 30 FT. RE 0 HAS BEEN PROVIDED TOT WELL OWNER. .-
(Use"+"if Above Top of Casing) �� n c 7 1
d. TOP OF CASING IS 1 FT.Above Land Surface* ' �Z
*Top of casing terminated at/or below land surface may require SIGNATURE OF IFIED ELL CONT TOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
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-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07

I
. ,
. ,
. ,
. ,
, .
. .
. .
. v
. . .
. i . .
. , .
. . .
. •
• I
• - .
. .
. . .
- .
• .
' .
. —.
..-*, ....
. . .
. .
.. .
. .
. ,
. .
. . . • .
. .
. .
. .
. ,
. . . ,
.. . I
..,•, ,
. u
I
. . .
. . , • .,. .
. .
. .
I
,
. . . . ,
. .
'..,.. .
, I• claw
. .
..•
,c. • . . .
. • . .. . ,
,..
. LI
••
......• .
. . •
.... . .
••• .
, . •
. .
. , .
. ,
. .
. .
. _
.. .
I
, • -.--:. .
._
. . .
. • • • -Ft 0499 59Pt2P,-(3,,...,
. ..
. .
., • ,.. ....
. • ..... ...
. ,
.. l .
, . .
... . I
. .
. •- '.•...
.... . .
. .
.. . 1,v... 1 • — ...'',.--
.
1 Q
•
. . ,
. '—I, '',: . .' ‘.... . •
• ••- • 10 L11.....' . ":". • .. . .
/-04 . ..... ..
r . .......
.........
I -
.: ../...r; . .
.. .''...f.
. I. .
. . I
. J .
. .
. . .
• A
,... .. ......
, .
, . .
. . .
. .•. .
. ...
. . .
. .
, • , . . ... .
• ...
. .
. . . .
. .
. .. .
• • , .
. .