GW1-2022-06387_Well Construction - GW1_20220603

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RESIDENTIAL WELL CONSTRUCTION REC RD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
n» WELL CONTRACTOR CERTIFICATION# 77$0 22"1
1.WELL CONTRACTOR: HTH 49
KEITH PRESNELL f. DISINFECTION:Type Amount
g. WATER ZONES(depth)':
Well Contractor Individual Name From 125 To 130 From To
DEVVEY WRIGHT 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 2WIN Depth Diameter Weight Material
From 0 To 30 Ft. 6 US .350 PVC
City or Town State Zip Code From To Ft.
( 8M )-264-2651 From To Ft.
Area code-Phone number 7.GROUT: Depth Material Method
2.WELLINFORMATION: From 0 To 20 Ft.BENTONTT Gravity Flow
—---
SITE WELL ID#(If applicable) -- -- -- ----—_--From--- __To
STATE WELL PERMIT#(if applicable) From To Ft.
DWO or OTHER PERMIT#[if applicable) 373905 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 5/1&2022 From To Ft. in. in.
TIME COMPLETED AM❑ PM From—TO—,Ft.—in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY: BOONE COUNTY WatsigliS From To Ft.
WELL#7 TOWNHOMES AT BROOXS=OFF TOW From _To Ft.—
From--TO—Ft.
(Street Name,Numbers,Community,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 50 DIRT
_ 36.2326$6 May be in degrees, 50 60 GRANITE
LATITUDE 3 minutes,seconds or
LONGITUDE -81.651626 in a decimal format 60 68 DIRT
Latitude/longitude source: IN GPS ❑Topographic map 68 125 GRANITE
(location of well must be shown on a USGS topo map and 125 130 QUARTZNOID
attached to this form if not using GPS) 130 246 GRANITE
4.WELL OWNER 245 249 QUARTZ
OWNER'S NAME RCPBD INVESTMENTS MC 249 305 GRANITE
STREET ADDRESS BOX 3018, r64
BOONE NC 28607 _
City or Town State Zip Code
( (8M )_963-3443
Area code-Phone number
5.WELLDETAILS: 11.REMARKS: t-' -
a. TOTAL DEPTH: 305 12 GPM 125-130 °+
UM
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOS]
C. WATER LEVEL Below Top of Casing: 60 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
RE RD HAS BEEN PROVIDED THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface* I
"Top of casing terminated at/or below land surface may require ✓
a variance in accordance with 15A NCAC 2C.0118 A 1�%
IGNAT RE OF CERTIFIED WELL CONTR OR DATE
e. YIELD(gpm): 12 METHOD OF TEST Air KEITH PRESNEI I 1
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
i
Submit the original to the Division of Water Quality within 30 days.Attn:Information Mgt., Form GW-1 a
1617 Mail Service Center-Raleigh, INC 27699-1617 Phone No.[phone] ext 568. Rev.7/05

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