GW1-2021-00293_Well Construction - GW1_20210127

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RESIDENTIAL WELL CONSTRUCTION RECORD
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_ North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2760 200204
1.WELL CONTRACTOR:
f. DISINFECTION:Type HTH Amount ?1
KEITH PRESNELL
9• WATER ZONES(depth):
Well Contractor(Individual Name)
From 200 To 201 From 37 To 380
DEWEY MIGHT WELL &PUMP CO., INC. From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P.O.BOX 308 6.CASING: Thickness/
BOONE NC 28607 Depth Diameter Weight Material
From 0 To 96 Ft. 61/8 •350 PVC
City or Town State Zip Code From To Ft.
( 828 ) 264-2651 From To Ft.
Area code-Phone number 7.GROUT: Depth Material Method
2.WELL INFORMATION: From 0 To_-_IQ Ft. BFNTONIT Gravity Flow
SITE WELL-ID-#(if applicable) _ -- _ __- From-- To
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(If applicable) 10694: &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water SupplyLK From To Ft. in. in.
DATE DRILLED 1/14/2021 From To Ft. in. in.
TIME COMPLETED 03:00 - AM l] PM From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY: NEWLP.ND COUNTY AVERY From To Ft.
1156 JONAS RIDGE HWY OFF HWY 181 OFF HWY 22 From _To Ft.
From To Ft.
(Street Name,Numbers,Communit)4 Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0 80 DIRT/SHALE
May be in degrees,
LATITUDE 3 _ minutes,seconds or 80 200 GRAY GRANITE
LONGITUDE _ in a decimal format 200 201 CREVICE
Latitttde/longitude source: OCGPS El Topographic map 20t 379 BLUE GRANITE
(location of well must be shown on a USGS topo map and 379. 380 CREVICE
attached to this form if not using GPS) 380 425, BLUE GRANITE
4.WELL OWNER
OWNER'S NAME
STREET ADDRESS%VPC BUILDERS 2059 TYNECASTLT
BANNER ELK NC 2$604. -
City or Town State Zip Code
460-2417.
Area code-Phone number
1 l:�a�bnb e.a ..,r•. is��'�i"ill
5.WELL DETAILS: 11.REMARKS U
a. TOTAL DEPTH: 425 0.5 GPM M-201 9.5 GPM 379-380
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOM.
c. WATER LEVEL Below Top of Casing: 70 FT. I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 15A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECPN HAS B!E!E>P1115vIDED T E WELL OWNER.
d. TOP OF CASING Is 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require P, ryV1141 r
a variance in accordance with 15A NCAC 2C.0118 SIGNATUAMF C IF1 VEL CO OR DATE
e. YIELD(gpm): 10 METHOD'OF TEST Air' KEITH PRESNELL
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn: Information Mgt., Form GW-1 a
1617 Mail Service Center-Raleigh, NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05