GW1-2022-06658_Well Construction - GW1_20220708

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CwQ~ RESIDENTIAL WELL CONSTRUCTION RECORD
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North Carolina Department of Environment and Natural Resources-Division of Water Quality
QU-^�'�c 2780 210122
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type 1-1TH Amount46
KEITH PRESNELL
g. WATER ZONES(depth):
Well Contractor(Individual Name) From 145 To 152 From 268 To 270
OEWE1r WRIGHT WELL &PUMP CO., INC.
From To From To
Well Contractor Company Name
P.O.BOX 308 From To From To
STREET ADDRESS 6.CASING: Thickness/
BOONE NC 286M Depth Diameter Weight Material
From 0 To 38 Ft. 6118 .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------GryiW-F1Ayd--•--- -
SITE WELL ID#(if applicable) From To Ft.21 BAGS
STATE WELL PERMIT#(if applicable) From To Ft.SELFCERT
DWQ or OTHER PERMIT#(if applicable) &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.:
DATE DRILLED 6/20/2022 From To Ft. in. in.
TIME COMPLETED AM 5 PM❑ From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
BANNER E X Way Depth Size ,—Mter J
p^�
CITY.. COUNTY From TO Ft. Ztt h n ay�p
LOT 48 MONTEAGLE OFF SHAVJNEE OFF GUALTN From _To Ft.
From To Ft. JUL 0 S
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG Drc� �_ g Un'
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) 0 29 DIRT
May be in degrees,
LATITUDE 3 36.191985 minutes,seconds or 29 145 GRANITE
LONGITUDE -81.84582 in a decimal format 145 152 QUARTZ
Latitude/longitude source: I GPS ❑Topographic map 152 220 GRANITE
(location of well must be shown on a USGS topo map and 220 235 SHALE
attached to this form if not using GPS) 235 268 GRANITE
4.WELL OWNER 268 270 VOID
OWNER'S NAME ' RUSSELL 270 305 GRANITE
TM WOODCOCK CONSTRUCTION, PO B0
STREET CAWESS °
City or Town State Zip Code
(0 0) 616-2895
Area code-Phone number
SWELL DETAILS: 305 11 GPM 145- 152 ;10 GPM 268-270
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOXI
c. WATER LEVEL Below Top of Casing: $0 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 PROVIDED TO TA WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface* <�l ( S1
"Top of casing terminated at/or below land surface may require ` / o'er
a variance in accordance with 15A NCAC 2C.0118 9�2 ra SI NATURE DIF CERTIFIEDWELI DATE
e. YIELD(gpm): 15 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: Information 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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