GW1-2022-08630_Well Construction - GW1_20220428

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
2780 ) 200049
WELL CONTRACTOR CERTIFICATION#
1.WELL CONTRACTOR: HTH 59
KEITH PRESNELL f. DISINFECTION:Type Amount
g. WATER ZONES(depth):
Well Cuutr 1 6� g 299
2�$
(I TO
hWLL & PUMP CO., INC. From To From
From To From To
Well Contractor Company Name From To From To
STREET ADDRESS P n BOX 308 6.CASING: Thickness/
BOONE NC 28607 Depth Diameter Weight Material
From 0 To 42 Ft. 6I14 .188 CIALV
City or Town State Zip Code From To Ft.
( 828 )-264-265I From To Ft.
Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From 0 To 20 Ft.BENT01M Gravity Flow
--- --SITE WELL ID-#Qf applicable) _ _ - From -.---TO--- Ft._ --- —------ --_ _
STATE WELL PERMIT#('dapplicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 278990 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 4/18/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY: BOONE COUNTY watagua From _To Ft.
262 HIDDEN CP=RD OFF EMDEN CREM OFF M From _To Ft.
From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
LXSlope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) be in0 35 MUDIGRAVEL
LATITUDE 3
N36*18.024 May minutes,s s degrees,econds or 35 42 BLUE GRANITE
w0
LONGITUDE 81�'40.145 in a decimal format 42 66 GRAY GRANITE
Latitude/longitude source: LN GPS ❑Topographic map 66 67 CREVICE
(location of well must be shown on a USGS topo map and 67 2138 GRAY GRANITE
attached to this form if not using GPS) 288 289 CREVICE
4.WELL OWNER 289 325 BLUE GRANITE
OWNER'S NAMEEDDI' &CE=A F ZINSI0
STREET ADDREsb/.TIMBER STRUCTURES INC. PO BOX 159 .r i_ 17F
BOONE NC 286t77
City or Town State Zip Code
(( 8N) )_964-3802
Area code-Phone number ' y
To
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5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 325 2 GPM 66-67 28 GPM 288-289
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOM
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
RECORD HAS BEEN PROVIDED HE WELL OWNER.
d. TOP OF CASING Is 1 Fr.Above Land Surface' _r]
"Top of casing terminated at/or below land surface may require 14
a variance in accordance with 15A NCAC 2C.0118 SIGNA E F IFIED ELL C R DATE
e. YIELD(gpm): 30 METHOD OF TEST Au KEITH PRESNELL i
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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