GW1-2023-00481_Well Construction - GW1_20230104

RESIDENTIAL WELL CONSTRUCTION RECORD
/ North Carolina Department of Environment and Natural Resources-Division of Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 220192-1
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1.WELL CONTRACTOR: f. DISINFECTION.Type HTH Amount 0
KEITH PRESNELL g. WATER ZONES(depth)::
Well Contractor(Individual)Name From To From To
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/
BOONE NC 28607 Depth Diameter Weight Material
From_To ?94 Ft._6 114 1 RR (,AI V
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 tFt-21 BAGS -WELL CONSTRUCTION PERMIT#183497 From To 'Ft.
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OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth ;Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply ID( From To Ft. in. in.
DATE DRILLED 12/14/2022 From To Ft. in. in.
TIME COMPLETED 03:00 AMU PM OX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: DRY HOLE COUNTY WATAUGA Depth Size Material
From To Ft.
WELL#1 LOT 33 OFF BOULDER CREEK DR OFF R From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
X Slope 0 Valley 0 Flat 0 Ridge 0 Other 11.DRILLING LOG
(check appropriate box)
LATITUDE 36.19096N May be in degrees, From TO Formation Description
—— minutes,seconds or 0 286 DIRT
LONGITUDE 81.71446W in a decimal format 286 330 GRANITR
— — 330 360 SHALE
Latitude/longitude source: X GPS 0 Topographic map 360 578 GRANITE
(location of well must be shown on a USGS topo map and 578 620 GRANITE QUARTZ MIX
attached to this form if not using GPS) 620 710 GRANITE
5.WELL OWNER 710 728 SHALE i
728 905 GRANITE -
OWNER'S NAME KENT WALKER%SATCHMO&CO, IN
STREET ADDRESS 2489 RUSS CORNETT RD Z�L3� .R
BOONE NC .28607
City or Town State Zip Code — ^�IV y v.--,g•,r
(828 )_ 964-1809
Area code- Phone number 12. REMARKS:
6.WELL DETAILS: DRY HOLE
a. TOTAL DEPTH: 905
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 ANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 0 FT. RECORD HAS BEEN PRO EDT i WELL OWNER.
(Use"+"if Above Tap of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface*
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'Top of casing terminated attor 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): 0 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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