GW1-2022-08767_Well Construction - GW1_20220909

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RESIDENTIAL WELL CONSTRUCTION RECORD
�C North Carolina Department of Environment and Natural Resources-Division of Water Quality
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WELL CONTRACTOR CERTIFICATION# 80 I 210221
1.WELL CONTRACTOR: I
f. DISINFECTION:Type HTH Amount 67
KEITH PRESNELL g, WATER ZONES(depth):
Well Contractor(Individual Name) From 272 To 278 From 365 To366
DEVVEY WRiGHT WELL &PUMP CO., INC. From To From To
Well Contractor Company Name From To - From To
STREET ADDRESS P.O.BOX 308 6.CASING: Thickness/
BOONE NC 28607 Depth Diameter Weight Material
From 0 To 85 Ft. 61/9 .350 PVC
City or Town State Zip Code From To Ft.
( = )264-2651 From To Ft.
Area code-Phone number 7.GROUT Depth Material Method
2.WELLINFORMATION: From 0 To 20 'Ft.BENTONIT Gravity Flow
SITE WELL ID#(if applicable) +._ From TO F S
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#of applicable) 127015 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply$] From To Ft. in. in.
DATE DRILLED 8/23/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM ElPMJ® From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY:BA1414EREIX COUNTY AVERY From To Ft.
From To Ft.
LOT 77 SUGAR MTN SUGAR POINT OFF GREEN CLi From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley ❑Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) ri 76 niRT
May be in degrees,
LATITUDE 3 36.11944$ minutes,seconds or 79 195 GRANITF
LONGITUDE -$1.8$124$ in adecimal format 195 205 QUARTZ
Latitude/longitude source: §P GPS ❑Topographic map 2W 272 GRANITE
(location of well must be shown on a USGS topo map and 272 278 PINK QI IART7
attached to this form if not using GPS) 27g65 GRAft11TF
4.WELL OWNER 65 66 Zinin
OWNER'S NAMEOENNI5 ANn'KRSON W6 ena GRANITE
STREET-ADDRESF`l'D Rl�r>,_RRD _ �
LJ
GREER
City or Town State Zip o e
CL D n � �n�n
((803) )-237-16914 �� �Z��
Area code-Phone number Infcrma4i n Pm,-:?,aa g Un i
5.WELL DETAILS: 11.REMARKS: `j`�Q/"013
a. TOTAL DEPTH: 40S 2 GDA.f n1_-279 19 GNMA 365_ -466
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOx❑ -
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 CONSTRUCT ON STANDARDS,AND THAT A COPY OF THIS
RECORD HAS BEEN PRO IDE THE WELL OWNER.
d. TOP OF CASING IS 1 FT.Above Land Surface' O)J 1
*Top of casing terminated aar below land surface may require
a variance in accordance with 15A NCAC 2C.0118 9IGNATTJRE OF CERrIFIED VMLL COT OR DATE
e. YIELD(gpm): 20 METHOD OF TEST Air
PRINTED NAME OF ERS76- CONSTRUCTING THE WELL
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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 569. Rev.7/05
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