GW1--07197_Well Construction - GW1_20231108

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�t RESIDENTIAL WELL CONSTRUCTION RECORD
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, North Carolina Department of Environment and Natural Resources-Division of Water Quality
� WELL CONTRACTOR CERTIFICATION# 2780 2301115
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 64
KEITH PRESNELL g. WATER ZONES(depth)
:
):
Well Contractor(Individual)Name From 230 To 235; From 320 To 325
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 To Ft.
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*Of applicable) From To Ft.
From To i Ft. -
WELL CONSTRUCTION PERMIT#396592 From To ti 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 10/26/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM DX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: DRILL DEEPER COUNTY WATAUGA Depth Size Material
From To Ft.
7858 NC HWY 105S 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 „ — 36.10016 minutes,seconds or 0 124 EXISTING WELL
LONGITUDE 81.45351 in a decimal format 124 230 GRANITE
— — 230 235 QUARTZ
Latitude/longitude source: X GPS o Topographic map 235 320 GRANITE '
(location of well must be shown on a USGS topo map and 320 325 QUARTZ
attached to this form if not using GPS) 325 345 GRANITE
5.WELL OWNER I l
I
OWNER'S NAME RUTH ANN TEAGUE ----
PO BOX 1070 ..-- ��' :I`�a...,j
STREET ADDRESS a
BOONE NC 28607 f19
City or Town State Zip Code 'NOV S 2423
( 828 )_ 963-4854 ,. .-
Area , ,,"_.
Area code- Phone number 12. REMARKS: u's'°; `'
10 GPM 230-235
6.WELL DETAILS: •
a. TOTAL DEPTH: 345 20 GPM 320 325 I
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 CONSTRUC ON,STANDARDS,AND THAT A COPY OF THIS
C. WATER LEVEL Below Top of Casing: 40 FT. RECORD HAS BEEN PRO• 'Ili.THE WELL OWNER.
(Use"+"if Above Top of Casing) / ^ �
d. TOP OF CASING IS 1 FT.Above Land Surface* / ���,, !o r34 4��5
*Top of casing terminated at/or below land surface may require SIGNATUR F CERTIFIED WELL CONT ACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL I ,
e. YIELD(gpm): 30 METHOD OF TEST AIR PRINTED NAME OF PERSONICONSTRUCTING THE WELL
1
1
Submit the original to the Division of Water Quality within 30 days. Attn: Informaltitn Mgt.,
Form GW-1 a
1617 Mail Service Center—Raleigh, NC 27699-1617 Phone No.[phone] ext 568.1 ' Rev.3/07

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