GW1--07905_Well Construction - GW1_20231205

STATF,yAA�
M1J N,.v.O,,, 4, • D
4, t a . RESIDENTIAL WELL CONSTRUCTION RECORD
3 North Carolina Department of Environment and Natural Resources-Division()If Water Quality
', --,'''' WELL CONTRACTOR CERTIFICATION# 2780 220004
Aar_
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 121
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 350 To 355 From 671 To 675
DEWEY WRIGHT WELL&PUMP CO., INC From To I 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 24 Ft. 6 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
From 0 To 20 Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable)__ __ _ From -- - To 1 Ft. 19 BAGS - --- -
WELL CONSTRUCTION PERMIT#354142 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 11/8/2023 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 COUNTY WATAUGA Depth Size Material
From To Ft.
550 DEWITT BARNETT RD OFF BAIRDS CREEK RI From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope II Valley 0 Flat 0 Ridge 0 Other
(check appropriate box) 11. DRILLING LOG
LATITUDE 36.212356 May be in degrees, From To Formation Description
— _ minutes,seconds or 0 5 DIRT
LONGITUDE 81.754654 in a decimal format 5 350 GRANITE
— — 350 355 GRANITE
Latitude/longitude source: X GPS 0 Topographic map 355 671 GRANITE
(location of well must be shown on a USGS topo map and 671 675 GRANITE
attached to this form if not using GPS) 675 705 GRANITE
5.WELL OWNER I rn -`" .'".1 A,. ;
OWNER'S NAME KARL MARTYN i X:...C.01- c lit—- r
STREET ADDRESS 351 CREEK VIEW LN
DEC 0 5 2023
BOONE NC 28607 -
City or Town State Zip Code hi;,:,ia,s".;,:,s P!'r•- 4r,;;rtq UFX
(828 )_ 719-6833 G'Vu"v :2JC;
Area code- Phone number 12. REMARKS:
1 GPM 350-355
6.WELL DETAILS: 1 GPM 671 675
a. TOTAL DEPTH: 705
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 CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 100 FT. RECORD HAS BE N ROVID T 'THE WELL OWNER. / G ,1(Use"+"if Above Top of Casing)
/(� 1 h !..� 'Z J
d. TOP OF CASING IS 1 FT.Above Land Surface* A.
*Top of casing terminated at/or below land surface may require SIGNATURE OF CER FIED WELL CONTRA TOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL j
e. YIELD(gpm): 2 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

.I. , +' -.
•
s.
7
r , •
__f
. • /. iC •
•
' • •
�a ;;
i . • . . . b . .
•
I� : ' •
;rda Cj)1ee - • .
•
r�r -. x•
.
• r