GW1-2022-06388_Well Construction - GW1_20220603

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RESIDENTIAL WELL CONSTRUCTION RECORD
�c North Carolina Department of Environment and Natural Resources-Division of Water Quality
2780
WELL CONTRACTOR CERTIFICATION# L(MJQb
1.WELL CONTRACTOR: f. DISINFECTION:Type ' HTH Amount 94
KEITH PRESNELL
g. WATER ZONES(depth):
Well Contractor(Individual Name) From 187 To 193 From 528 To 329
LDEWEY WRIGHT WELL &PUMP CO., INC.
From To From To
Well Contractor Company Name From To From To
P.O.BOX 308
STREET ADDRESS 6.CASING: Thickness/
BOONE NC 28607 Depth Diameter Weight Material
From 0 TO 80 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 20 'Ft BENTONIT Gravity Flow
- - SITE WELLID""#('rf applicalil7-= - - -- - - ----- ----From- --To- Ft;70.RAGS -- --
STATE WELL PERMIT#(a applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 373906 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To-'Ft.-in. in.
DATE DRILLED 5/1712022 From-TO-,Ft.-
romToFt. in. in.
TIME COMPLETED 03:00 AM❑ PM From To Ft. in. in.
9.SAND/GRAVEL PACK: i
&WELL LOCATION:
Depth Size Material
CITY.. BOONTE COUNTY W=lwa From _To Ft.
WELL 48 TOWNHOMES AT BROOYMME 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 69 DIRT
_ 36.233770 May in degrees, 69 187 GRANITE
LATITUDE 3 minutes,seconds or
LONGITUDE -81.653459 in a decimal format 187 193 SHALE
Latitude/longitude source: I GPS ❑Topographic map 193 322 GRANITE
(location of well must be shown on a USGS topo map and 322 370 SHALE
attached to this form if not using GPS) 370 391 GRANITEIQUARTZ
4.WELL OWNER 391 472 GRANITE
OWNER'S NAME RCPBD ' S LLC 472 528 GRANITEIQUARTZ
-.___STREE-ADDRESS$dX 3D18• 525:_ 529. VOID— VC6
BOONE NC 28607 529 656 GRANIT v
City or Town State Zip Code
( (8= 1- 963-3443 JUN 0 2022
Area code-Phone number
5.WELL DETAILS: 11.REMARKS: j �
a. TOTAL DEPTH: 565
1 GPM 187- 193 14 GPM �'$'�-- sit,p F ,,.)'•;r-�' '".s
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOXI
c. WATER LEVEL Below Top of Casing: 100 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
RECORD HAS BEEN PROVID THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTIFIED WELL COITITACTOR DATE
e. YIELD(gpm): 15 METHOD OF TEST Air KEITH PRESNELL
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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Submit the original to the Division of Water Quality within 30 days.Attn: Information Mgt., Form GW-1a
1617 Mail Service Center-Raleigh, NC 27699-1617 Phone No. [phone] extj 568. Rev.7/05

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