GW1-2022-08687_Well Construction - GW1_20220428

i
RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
210293
WELL CONTRACTOR CERTIFICATION# 2780
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 70
KEITH PRESNELL
g. WATER ZONES(depth):
Well Contractor(Individual Name)) From 192 To 202 From 360 To 369
DEWEY WRIGHT WELL &PUMP CO., INC.
From To From To
Well Contractor Company Name From To From To
P. O.BOX 308
STREET ADDRESS 6.CASING: Thickness/
BOONE NC 2860 Depth Diameter Weight Material
From 0 To 58 Ft. 61/9 .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 Flow
- —SITE WELL ID#(if applicable)— - - ------ --From- - _-To -Et.25 BAGS
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 309577 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 4/15/2022 From To Ft. in. in.
TIME COMPLETED 03.00 AM❑ PM From To Ft. in. in.
9.SAND/GRAVEL PACK:
3.WELL LOCATION:
Depth Size Material
CITY. BOONE COUNTY Watia= From To Ft.
OFF DOUGHERTY FARM LN OFF Vyr=N RIDGE O 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)36 0 49 DIRT
207375. May in degrees, 49 192 GRANITE
LATITUDE 3 minutes,seconds or
LONGITUDE -81.637816 in a decimal format 192 202 QUARTZ
Latitude/longitude source: IN GPS ❑Topographic map 202 230 SHALE
(location of well must be shown on a USGS topo map and 230 280 GRANITE
attached to this form if not using GPS) 280 . 3W SHALE
4.WELL OWNER 308 360 GRANITE
OWNER'S NAMEAL" BURC_HC 7_ 360 36$
STREET ADDRESSPO BOX 1430, 368 425 TMAN E- f—
BOONE NC 28607 APR o Q �n�9
City or Town State Zip Code `
(8M 963-0853
Area code-Phone numberMa,G O`
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 425 1 GPM 192-202 .2 GPM 360-368
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOXI
80
c. WATER LEVEL Below Top of Casing: 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 yAS BEEN PROVID 0 THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface* L r1
*Top of casing terminated at/or below land surface may require tch a variance in accordance with 15A NCAC 2C.0118 GNA RE OF CrIRTAIRYWELL NT CTOR DATE
e: YIELD(gpm): 3 METHOD OF TEST KEITH PRESNELL
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
r
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, INC 27699-1617 Phone No.[phone] ext 5 f.; Rev.7/05

�R Y