GW1-2023-01806_Well Construction - GW1_20230223

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a %' RESIDENTIAL WELL CONSTRUCTION RECORD
1,' North Carolina Department of Environment and Natural Resources-Division of Water Quality
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. ,„ "'.- WELL CONTRACTOR CERTIFICATION# 2780 220179
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 95
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 190 To 205 From 460 To 462
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 140 Ft. 6 1/8 350 P\/('
. 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
From 0 To 20 Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) From To Ft. 25 BAGS
WELL CONSTRUCTION PERMIT#272945 From To Ft. •
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply!'( From To Ft. in. in.
DATE DRILLED 2/8/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AMU . PM D)( From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA Depth • Size Material
From To Ft.
LOT#2 OFF BAMBOO RD OFF DEERFIELD OFF 32 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 II Ridge 0 Other 11.DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE — — 36.18795N minutes,seconds or 0 130 DIRT
LONGITUDE 81.60966W in a decimal format 130 190 GRANITE
— — 190 205 RED GRANITE
Latitude/longitude source: X GPS 0 Topographic map 205 275 GRANITE
(location of well must be shown on a USGS topo map and 275 300 GRANITE QUARTZ MIX
attached to this form if not using GPS) 300 325 RED QUARTZ
5.WELL OWNER 325 460 GRANITE
460 462 VOID
OWNER'S NAME MICHAEL WILDER C/O BOONE CON: 462 505 GRANITE ^;"` c•a 2,'
STREET ADDRESS 189 CALLOWAY RD t^" -. "'r;:- 5 F` �'� '--
BOONE NC 28607 FED 2� S. Z02.3
City or Town State Zip Code
(828 )- 773-1685
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Area code- Phone number 12. REMARKS: r`'' '`"'�'-
1 GPM 190-205
6.WELL DETAILS: 29 GPM 460-462
a. TOTAL DEPTH: 505
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRU •N STANDARDS,AND THAT A COPY OF THIS
C. WATER LEVEL Below Top of Casing: 30 FT. RECORD HAS BBlEEE'NNPPP OVIDE' I HE WELL OWNER.
(Use"+"if Above Top of Casing) iCrf( � /]�� 2 Jd. TOP OF CASING IS 1 FT.Above Land Surface* ✓ V'-`3 v300*Top of casing terminated at/or below land surface may require f#4.L
NATURE OF CERTIFIED WELL CONTR TOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 30 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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