GW1-2023-02367_Well Construction - GW1_20230331

t lk .
RESIDENTIAL WELL CONSTRUCTION RECORD
- �' North Carolina Department of Environment and Natural Resources-Division of Water Quality
3 ,s"' ' WELL CONTRACTOR CERTIFICATION# 2780 220184
•
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 34
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 118 To 121 From 180 To 185
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 D To 90 Ft. 6 1/R 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: 25 BAGS
WELL CONSTRUCTION PERMIT#015971 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 3/29/2023 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#43 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 II Valley II Flat 0 Ridge 0 Other
(check appropriate box) 11. DRILLING LOG
May be in degrees, From To Formation Description
LATITUDE _ 36.16613N minutes,seconds or 0 80 MUD DIRT
LONGITUDE_ _ 81.89080W in a decimal format S08 1281 GRANITE
GRANITE
Latitude/longitude source: X GPS 0 Topographic map 121 180 GRANITE
(location of well must be shown on a USGS topo map and 180 185 GRANITE
attached to this form if not using GPS) 185 220 GRANITE
•5.WELL OWNER
OWNER'S NAME GEORGE MEYER REV TRUST CIO VI .T r :--„
STREET ADDRESS 198 BUCK CREEK RD
ROAN MTN TN 37687 MAK it .( l[I23
City or Town State Zip Code Ir 4 ' LL
(828 )_ 260-1883 .• ...=W, 'I r
Area code- Phone number 12. REMARKS:
5 GPM 118-121 �
6.WELL DETAILS: 35 GPM 180 185
a. TOTAL DEPTH: 220
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. R HAS B EN ROVIDED1 HE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* / t•�����. ('t - 2_0. _3
*Top of casing terminated at/or below land surface may require SIGNATURE OF CERTIFIED UPELL CON A OR 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

\X kkt
-tbt
t&)
\41.
-c..0%.
•
c.•••
f/
1 .
STOP
-1/40
Ng-
1_0
• bv\Viilc /05
_ _ _