GW1-2022-06389_Well Construction - GW1_20220603

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# V20 [ 220083
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 131
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual Name) From 196.To 202 From 690 To
Ll.E11VEY"ARIGHT 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 22607 Depth i Diameter Weight Material
From 0 To 70 Ft! 6118 .350 PVC
City or Town State Zip Code From To Ft:
-264-2651 From To Ft.
Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth i Material Method
From 0 To 20 Ft.BENTONTT Gravity Flow
- —""SITE"WELL ID'#(rfapplicatile)—` `. _ _ .__----_-- —.From— -To--- --- -Ft.--20-BACTS— --
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 373908 8.SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 5/20/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM 91 From . To Ft. in. in.
9.SAND/GRAVEL PACK:
3.WELL LOCATION:
Depth Size Material
CITY: BOONE COUNTY Wata=a From TO Ft.
WELL#9 TOWNHOMES AT BROOKSHME 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 61 GIRT
May be in degrees,
LATITUDE 3 36.233783 minutes,seconds or 61 196 GRANITE
LONGITUDE -81.653715 in a decimal format 196 202 QUARTZ
Latitude/longitude source: ISGPS ❑Topographic map 202 355 GRANITE
(location of well must be shown on a USGS topo map and W5 380 SHALE
attached to this form if not using GPS) 38p 510 GRANITE
4.WELL OWNER 510 520 GRANITEIQUARTZ
OWNER'S NAME RCPBD INVESTNMITS LLC 520 700 GRANIT
STREET-ADDRESSPO BOX 301S _. __._ _ -- - "-_—
BOONE NC 28607 I� -
City or Town State Zip Code
(( 8N) )_963-3443
Area code-Phone number %:M'loi
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 700 5 GPM 196-202 5 GPM 690-
b. DOES WELL REPLACE EXISTING WELL? YES❑ NO)Q
c. WATER LEVEL Below Top of Casing: 30 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
REC H S BEEN PRO"DED E WELL OWNER.
d. TOP OF CASING IS l FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require FEW3/ O
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE-OF-CEliffIVIED VIVELL colSTTRAVrOR DATE `
i
e. YIELD(gpm): 10 METHOD OF TEST Air KEITH PRESNELL
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
I
Submit the original to the Division of Water Quality within 30 days.Attn: Informati�n1 Mgt., Form GW-1 a
1617 Mail Service Center- Raleigh,NC 27699-1617 Phone No.[phone] ext,568. Rev.7/05

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