GW1-2023-00585_Well Construction - GW1_20230109

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RESIDENTIAL WELL CONSTRUCTION RECORD
North Carolina Department of Environment and Natural Resources-Division off Water Quality
WELL CONTRACTOR CERTIFICATION# 2780 '220126
1.WELL CONTRACTOR: f. .DISINFECTION:Type HTH Amount 151
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 194 To 203 ! 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/
Depth Diameter Weight Material
BOONE NC 28607 From_0 To_g$_Ft. R 1/A 3.0 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
- - SITE WELL ID#(if applicable) From 0 To 20 Ft. BENTONIT GRAVITY
From To Ft. 19 BAGS
WELL CONSTRUCTION PERMIT#368247 From To Ft.
OTHER ASSOCIATED PERMIT#(if applicable)
9. SCREEN: Depth Diameter Slot Size Material
3.WELL USE(Check Applicable Box): Residential Water Supply IX From To Ft. in. in.
DATE DRILLED 1/4/2023 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- BOONE COUNTY WATAUGA Depth Size Material
From To '• Ft.
OFF OLD HAMPTON RD OFF LITTLE LAUREL OFF From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To t Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope O Valley X Flat O Ridge 0 Other 11.DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE — — 36.11368 minutes,seconds or 0 80 DIRT
LONGITUDE 81.54755 in a decimal format 80 194 GRANITE
— — 194 203 QUARTZ
Latitude/longitude source: X GPS 0 Topographic map 203 390 GRANITE r
(location of well must be shown on a USGS topo map and 390 410 SHALE
attached to this form if not using GPS) 410 460 GRANITE QUARTZ
5.WELL OWNER 460 530 GRANITE I 6 Q 2R 3
530 548 SHALE
OWNER'S NAME NICOLAS KANIPE 548 720 GRANITE
720 740 GREEN GRANITE
STREETADDRESS 505 PINEY SHADE TRAIL 740 905 GRANITE
BOONE NC 28607
City or Town State Zip Code
(828 )- 390-1502
Area code- Phone number 12. REMARKS:
6.WELL DETAILS: 2.5 GPM 194-203
a. TOTAL DEPTH: 905
b. DOES WELL REPLACE EXISTING WELL? YES 0 NOI#C 1 DO HEREBY CERTIFY THAT THIS,WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRUCTIO TANDARDS,AND THAT A COPY OF THIS
C. WATER LEVEL Below Top of Casing: 100 FT. RE S BEEN PROVIDED T E WELL OWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface* {`��
*Top of casing terminated at/or below land surface may require SIGNATURE O E IFIED WELL CONTRA OR DATE
a variance in'accordance with 15A NCAC 2C.0118. KEITH PRESNELL 1
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 `7 1 a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568 1 Rev.310
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