GW1-2022-08185_Well Construction - GW1_20220419

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RESIDENTIAL WELL CONSTRUCTION RECOIRD
�C North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 70
KEITH PRESNELL
g. WATER 1ZgONESl(cl pth):;
well Curt r I �dulr�a�)a�Ti WELL &PUMP CO., INC. From To 99 From To
From To From To
Well Contractor Company Name From To From To
P.O.BOX 308
STREET ADDRESS 6.CASING: Thickness/
BOONE NC 28607 Q Depth Di ter Wei ht M tterial
From To 64 Ft. iis t
Prvc
City or Town State Zip Code From To Ft.
( SM_)-2.64-2651 From To Ft.
Area code-Phone number I
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From 0 To 64 Ft.CEN= PUTAPED
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 332462 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply IN From To Ft. in. in.
DATE DRILLED 3/29/2022 From To Ft. in. in.
TIME COMPLETED AM❑ PM From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY. BOONE COUNTY Vlat = From To Ft.
LOT 11 YONAHLOSSEE WETIERLY NEW BIGGIN F 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 22 DIRT
May be in degrees,
LATITUDE 3 36.177198 minutes,seconds or 22 50 SHALE ROCK
LONGITUDE -81.712710 in a decimal format 50 187 A GRANITE
Latitude/longitude source: X GPS ❑Topographic map 187 196 QUARTZ
(location of well must be shown on a USGS topo map and 195 322 GRANITE
attached to this form if not using GPS) 322 3W GREEN GRANITE
4.WELL OWNER 330 425 GRANITE
OWNER'S NAMEMRUSXA XONANC
STREET ADDRESS°LARRY NORRIS CONSTRUCTION, 1467 I
BOONE NC 286(Y1 �R IT:M
City or Town State Zip Code L.
( (SM _773-1708 APR 1 A 9n22
Area code-Phone number `� `�
5.WELL DETAILS: 11.REMARKS: Irt wwmbon Procew4ngl UnA
a. TOTAL DEPTH: 425 2 GPM 187- 196 rD%V=013
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOXI
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c. WATER LEVEL Below Top of Casing: 80 FT. 1 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 RD HAS BEEN PR VI D TO TELL 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 CONTRACTOR DATE
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e. YIELD(gpm): 2 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-1 a
1617 Mail Service Center-Raleigh,NC 27699-1617 Phone No.[phone] ext 568. Rev.7/05
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