GW1-2022-09213_Well Construction - GW1_20220930

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3 — RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 95
KEITH PRESNELL
g. WATER ZONES(depth):
Well Contractor(Individual Name) From 380 To 390 From TO
DE'WEY WRIGHT VVELL &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 154 Ft. 6119 .350 PVC
City or Town State Zip Code From To Ft.
= )�4 2651 From To Ft.
Area code-Phone number
2.WELL INFORMATION: 7.GROUT: Depth Material Method
From 0 To 20 FtBE_NTONIT &ayityFlow
SITE WELL ID#(if applicable) From To Ft.
STATE WELL PERMIT#(if applicable) From To Ft.
DWQ or OTHER PERMIT#(if applicable) 362595 &SCREEN: Depth Diameter Slot Size Material
WELL USE(Check Applicable Box): Residential Water Supply From To Ft. in. in.
DATE DRILLED 919/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM❑ PM)EJ From To Ft. in. in.
9.SAND/GRAVEL PACK:
&WELL LOCATION:
Depth Size Material
CITY.BOONE COUNTY WATAUGA From _To Ft.
MALLARD IN OFF CUNT NORRIS OFF 194 OFF 421 From To Ft.From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code)
TOPOGRAPHIC/LAND SETTING: 10.DRILLING LOG
❑Slope ❑Valley n7 Flat ❑Ridge ❑Other From To Formation Description
(check appropriate box) n 1d5 DIPT
May be in degrees,
LATITUDE 3 36.236275 minutes,seconds or 14S 21n GRANITF
LONGITUDE _S1. p in a decimal format 210 23n
Latitude/longitude source: W GPS ❑Topographic map 230 380 GRANITE
(location of well must be shown on a USGS topo map and 380 3W QUARTZ
attached to this form if not using GPS) 390 455 GRANITE SFA u
4.WELL OWNER 465 490 SHALE
OWNER'S NAME TN&TT illi_ JRF'S OF BOONE I LC 49n 6M GRANITE
STREET ADDRES,T ROY 1075 —'RQQNR
NC 1IC 28f607
City or Town State Zip Code_
(fS= )-773-657S
Area code-Phone number
5.WELL DETAILS: 11.REMARKS:
a. TOTAL DEPTH: 605 t r, 320_ 2-90
b. DOES WELL REPLACE EXISTING WELL? YES❑ NOX❑
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c. WATER LEVEL Below Top of Casing: 1 10 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 PROVIDED j E WELL OWNER.
d. TOP OF CASING IS 7 FT.Above Land Surface* I �7
*Top of casing terminated at/or below land surface may require /
a variance in accordance with 15A NCAC 2C.0118 SIGNATURE OF CSRTIFIED'WELL_CONTR7ZTOR DATE
e. YIELD(gpm): 1 METHOD OF TEST Air KE1�-4 RRESNIELI
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days.Attn: Inform ation1Mgt., Form GW-1a
1617 Mail Service Center-Raleigh, NC 27699-1617 Phone No.[phone] ext 566. Rev.7/05
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