GW1-2022-00344_Well Construction - GW1_20221222

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T RESIDENTL4L WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 220062
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 67
KEITH PRESNELL I'•
g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 230 To 258 ' From 378 To 380
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/
Depth Diameter Weight Material
BOONE NC 28607 From n _To 100 ",Ft.
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 j Material Method
From 0 To 20 Ft. BENTONIT GRAVITY
_SITE WELL ID#(if applicable) - --From- -- To- �Ft.`19-BAGS- -
WELL CONSTRUCTION PERMIT#360447 From To '•Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth j Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply IX From To Ft. in. in.
DATE DRILLED 12/9/2022 From To 'Ft.—in. in.
TIME COMPLETED_03:00 AMR PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: BOONE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF EAGLE DR OFF FAIRWAY DR OFF HWY 321 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 —— 39.191296 minutes,seconds or 0 91 DIRT
LONGITUDE 81.648527 in a decimal format 91 210 _GRANITE
— — 210 230 SHALE
Latitude/longitude source: X GPS 0 Topographic map 230 258 QUARTZ
(location of well must be shown on a USGS topo map and 258 378 GRANITE
attached to this form if not using GPS) 378 380 VOID!
5.WELL OWNER 380 405 GRANITE
OWNER'S NAME RICHARD ROBBINS %LARRY NORRI
STREET ADDRESS 1467 BIG HILL RD
BOONE NC 28607 2022
City or Town State Zip Code -
(828. )- 773-1708yZ.yar.�7 L ,a
Area code- Phone number 12. REMARKS:
2 GPM 230-258
6.WELL DETAILS: 18 GPM 378-380
a. TOTAL DEPTH: 405
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 CONSTRU ON STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 80 FT. RECORD HAS B EN PROVIDE THE WELL OWNER. / p�
(Use"+"if Above Top of Casing) V d. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated atlor below land surface may require SIGNATURE OF CERTIFIED WELL CONT C R DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL j
e. YIELD(gpm): 20 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:Informatil n 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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