GW1-2022-00346_Well Construction - GW1_20221222

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: RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division ofjWi ter Quality
WELL CONTRACTOR CERTIFICATION# 2780 220210
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1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 121
KEITH PRESNELL g. WATER ZONES(depth):'
Well Contractor(Individual)Name From 0 To 425 From 658 To 675
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 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 Material Method
SITE WELL ID#(if applicable) From 0 To ilFt.
_ From To - jFt':WELL CONSTRUCTION PERMIT#166629 From To IFt.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply X From—To—Ft—in. in.
DATE-DRILLED 12/2/2022 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: DRILL DEEPER COUNTY WATAUGA Depth Size Material
From To Ft.
464 OLD ORCHARD RD OFF VALLEY VIEW OFF W From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope 0 Valley 0 Flat O Ridge 0 Other 11.DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE __ 36.12488N minutes,seconds or 0 425 EXISTING
81.68866W in a decimal format 425 570 GRANITE
LONGITUDE_ _ 570 610 SHALE
Latitude/longitude source: X GPS 0 Topographic map 610 658 GRANITE
(location of well must be shown on a USGS topo map and 658 675 GRANITE/QUARTZ
attached to this form if not using GPS) 675 720 GRANITE
720 738 SHALE! n..!r" 't3:�• '•'' ll`�,1 J
5.WELL OWNER 738 805 GRANITE �� ,+_e ��r F>�•�'
OWNER'S NAME RICHARD LEWIS%PARADIGM CUST I
STREET ADDRESS 8562 HWY 105 S nr( � 2022
BOONE NC 28607
City or Town State Zip Code .; :%JV
(828 )_ 964-0048
Area code- Phone number 12. REMARKS:
0-425 1 GPM
6.WELL DETAILS:
a. TOTAL DEPTH: 805 658-675 1.5 GPM
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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 CONSTRUCTION;STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 200 FT. RECORD HAS BE P OVIDED THE WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface'
"Top of casing terminated atlor below land surface may require SIGNATURE OF CERTIFIED WELL C TRACTOR DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
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e. YIELD(gpm): 2.5 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 568! Rev.3/07
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