GW1-2022-10691_Well Construction - GW1_20221205

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RESIDENTIAL WELL CONSTRUCTION RECORD
8 North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 220058
1.WELL CONTRACTOR: f. DISINFECTION:Type •HTH Amount 130
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name From 230 To 238 From 838 To 842
DEWEY WRIGHT WELL&PUMP CO., INC From To From To
Well Contractor Company Name From To From To
STREET ADDRESS PO BOX 308 7. CASING: Thickness/
BOONS NC 28607 From Depth
Diameter Weight Material
�—Ft. R 1/8 150 PVC
City or Town State Zip Code From To Ft.
8( 28 )-264-2651 From—To—Ft.—
Area code- Phone number
2.WELL INFORMATION: 8. GROUT: Depth Material Method
From 0 To 20 � Ft. BENTONIT GRAVITY
SITE WELL ID#(if applicable) _ _ _ , _— --From - To------t Ft-20-BAGS =- ---- -- -~ -1
�r WELL CONSTRUCTION PERMIT#329808 From To ( Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth I Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply X From To Ft. in. in.
DATE DRILLED 11/29/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: DEEP GAP COUNTY WATAUGA Depth Size Material
From To Ft.
1505 WILDCAT RD OFF OLD 421 OFF 421 From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND.SETTING:
0 Slope 0' Valley X Flat 0 Ridge 0 Other 11.DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE __ 36.19782N minutes,seconds or 0 71 DIRT
81.49657W in a decimal format 71 230 GRANITE
LONGITUDE_ _ 230 238 QUARTZ
Latitude/longitude source:X GPS o Topographic map 238 360 GRANITE r
(location of well must be shown on a USGS topo map and 360 392 SHALE =" -
attached to this form if not using GPS) 392 540 GRANITE
540 552 GRANITE QUARTZ qq
5.WELL OWNER 552 710 GRANITE 202
OWNER'S NAME OMAR ESQUIVEL% CASH CUSTOM 710 720 QUARTZ
STREET ADDRESS 870 NC HWY 105 BYPASS 720 838 GRANITE
838 842 QUARTZ
BOONS NC 28607
842 865 GRANITE
City or Town State Zip Code
(828 )- 773-4889
Area code- Phone number 12. REMARKS:
.75 GPM 230-238
s.WELL DETAILS: 9.25 GPM 838-842
a. TOTAL DEPTH: 865
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTR ION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 200 FT. RECO D HAS BEEN PROV10 D 0 THE WELL OWNER.
(Use"+"if Above Top of Casing) /n�� j_^ � ; � 70
d. TOP OF CASING IS 1 FT.Above Land Surface' V/
.'Top of casing terminated atfor below land surface may require SIGNATURE OF CERTIFIED,,WELL CONTRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 10 METHOD OF TEST AIR PRINTED NAME OF PERSON 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 668. I Rev.3/07

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