GW1-2022-07082_Well Construction - GW1_20220801

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
91 WELL CONTRACTOR CERTIFICATION#
2780 ! 220044
1.WELL CONTRACTOR:
f. DISINFECTION:Type �T'I Amount 106
KEITH PRESNELL
g. WATER ZONES(depth):
Well Contractor(Individual Name) From 330 To 346 From To
DEVVEY WRIGHT WELL &PUMP CO., INC. From TO From To
Well Contractor Company Name From To From To
STREET ADDRESS P O.BOA 308 6.CASING: Thickness/
BOONS NC 28607 Depth Diameter Weight Material
From C 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 80 FtBENrONIT Gravity Flow
SITE WELL ID#(if applicable) From To Ft— 6-BAGS--
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 246645 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply)l From To Ft. in. in.
DATE DRILLED 7/21/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ POO From To Ft. in. in.
9.SAND/GRAVEL PACK:
3.WELL LOCATION:
Depth sipr—CEMIED
CITY: CR.ZTLDLER COUNTY A�nHE From To Ft. t:
From _To Ft.—A.t tC n 1 2027
LOT 57 HIDDEN IvITN/AI7T'CTt�d LEAF WAYIE HIDD From _To Ft.-
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) n P1069
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley;p Flat ❑Ridge ❑Other From TO Formation Description
(check appropriate box) 0 67 DIRT
May be in degrees,
LATITUDE 3 .31p..5d5313 minutes,seconds or 67 210 -GRANITE
LONGITUDE in a decimal format 210 260 SHALE
Latitude/longitude source: X'I GPS ❑Topographic map 260 3W GRANITE
(location of well must be shown on a USGS topo map and 330 346 QUARTZ
attached to this form if not using GPS) 346 385 SHALE
4.WELL OWNER 385 511 GRANITE
OWNER'S NAMEPETER OXREPKY 511 520 QUARTZ
STREET ADDRES,4716 BLUFF CT. 520 560 SHALE
RAIMGH NC 27615 560 705 GRANITE
City or Town State Zip Code
f9( 19 )-274-4002
Area code-Phone number
5.WELL DETAILS: It.REMARKS:
a. TOTAL DEPTH: 705 3 C*FM 330-346
b. DOES WELL REPLACE EXISTING WELL? YES❑ Now +
C. WATER LEVEL Below Top of Casing: 200 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 WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface' ' rs 4—^ �J
Top of casing terminated at/or below land surface may require pS p�
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CERTI ED WELL CONTRACTOR DATE
e. YIELD(gpm): 3 METHOD OF TEST Air KEITH PRESNELL
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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] ext'568. Rev.7/05
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