GW1-2023-02366_Well Construction - GW1_20230331

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O , t RESIDENTIAL WELL CONSTRUCTION RECORD
-, g North Carolina Department of Environment and Natural Resources-Division of:Water Quality
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`Z:::4'" WELL CONTRACTOR CERTIFICATION# 2780 220183
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 48
KEITH PRESNELL g. WATERZONES(depth):
Well Contractor(Individual)Name From 215 To 220 From 270 To 275
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 130 Ft. 6 1/6 350 PVC
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:20 BAGS -
___
WELL CONSTRUCTION PERMIT#015970 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 3/27/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX From To Ft: in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BANNER ELK COUNTY AVERY Depth Size Material
From To Ft.
LOT#36 SILVER SPRINGS SUBDIVISION OFF 194( 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 — — 36.16729N minutes,seconds or 0 118 DIRT
LONGITUDE 81.89043W in a decimal format 118 215 GRANITE
— — 215 220 GRANITE
Latitude/longitude source: X GPS 0 Topographic map 220 270 GRANITE
(location of well must be shown on a USGS topo map and 270 275 GRANITE
attached to this form if not using GPS) 275 300 GRANITE
5.WELL OWNER ,
OWNER'S NAME GEORGE MEYER REV TRUST C/O V(
STREET ADDRESS 198 BUCK CREEK RD i--- -— - -,..-
ROAN MTN TN 37687 f ,_--\\ 4_T, " t, -' '
City or Town State Zip Code
(828 )- 260-1883 MAR 3 '• 2023
Area code- Phone number 12. REMARKS: �
5 GPM 215-220 ,,,s�„...a� . r n ,.,_ ,.-:3 Una
6.WELL DETAILS: 25 GPM 270-275 u.a �„��
a. TOTAL DEPTH: 300
•
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 CONSTRUCT STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 60 FT. RE HAS,BEE R IDED T E WELL 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 SIGNA RE OF CERTI IE� R�CTO ! 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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