GW1-2022-06394_Well Construction - GW1_20220603

RESIDENTIAL WELL CONSTRUCTION RECORD
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North Carolina Department of Environment and Natural Resources-Division of Water Quality
« .0 ' 2780 ; 210255
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type I HTH Amount 45
KEITH PRESNELL
g. WATER ZONES(depth)`
Well Contractor(Individual Name) From 179 To 188 From 292 To 293
DEWEY VAIGHT 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 162 Ft. 6118 .350 PVC
City or Town State Zip Code From To Ft.
( 828 )264-2651 From To Ft.
Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From 0 To 20 Ft.BENTONIT Gravity Floes:
SITE-WELL-ID#(if applicable)---- —— -- -- ---—--From—- To---- - Ft:27 BAGS
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(If applicable) 3W736 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From—To—;Ft.—in. in.
DATE DRILLED 6/212022 From To—:Ft.—in. in.
TIME COMPLETED AM❑ PA From TO Ft. in. in.
3.WELL LOCATION: 9.SAND/GRAVEL PACK:
Depth Size Material
CITY. BOONE COUNTY Watagua From TO Ft.
OFF GREENSTONE RD OFF RUSS CORNETT OFF DI 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) 0 151 DIRT
_
LATITUDE 3 36.1M50 May be in degrees, 151 179 GRANITE
minutes,seconds or
LONGITUDE -81.693919 in a decimal format 179 186 QUARTZ
Latitude/longitude source: d GPS ❑Topographic map 186 254 GRANITE
(location of well must be shown on a USGS topo map and 254 260 LIMESTONE
attached to this form if not using GPS) 260 292 GRANITE
4.WELL OWNER 292 293 VOID
OWNER'S NAMEJUSTIN ICENT 293 3W GRAN
STREET ADDRESSyQ MCGUIRE CONSTRUCTION, PO BOX-157
BOONE NC 28607 0 a
City or Town State Zip Code773-3076
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 300 8 GPM 179- 186 42 GPM 292-293
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOX]
c. WATER LEVEL Below Top of Casing: 80 FT. I DO HEREBY CERTIFY THAT THISIWELL WAS CONSTRUCTED IN ACCORDANCE WITH
(Use"+"if Above Top of Casing) 16A NCAC 2C,WELL CONSTRUCTION STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO E 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 SIGKAW CMVIE15W ONT-Mm=R DATE
e. YIELD(gpm): 50 METHOD OF TEST Air KEITH PRESNELL
11 PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn: Informatio 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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