GW1-2023-00885_Well Construction - GW1_20230118

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RESIDENTIAL WELL CONSTRUCTION RECORD
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North Carolina Department of Environment and Natural Resources-Division of Water Quality
JA N 8 2023
WELL CONTRACTOR CERTIFICATION# 2780 220084
1.WELL CONTRACTOR:
L DISINFECTION:Type HTH Amouhtf
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 128 To 134 From 168 To 169
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 n To_80_Ft. R 1/8 350 PVt,
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 _— _ Ft.-24_BAGS_ ----_WELL CONSTRUCTION PERMIT#367481 From To Ft.
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 1/11/2023 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.
RAVENS RIDGE CIRCLE OFF RAVENS RIDGE OFF 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 — _ 36.20910N minutes,•seconds or 0 72 DIRT
LONGITUDE 81.63727W in a decimal format 72 128 _GRANITE
— — 128 134 _QUARTZ_
Latitude/longitude source: X GPS o Topographic map 134 168 GRANITE
(location of well must be shown on a USGS topo map and 168 169 VOID
attached to this form if not using GPS) 169 205 GRANITE
5.WELL OWNER
OWNER'S NAME WAYNE CLAWSON C/O CASH COST(
STREET ADDRESS 870 NC HWY 105 BYPASS
BOONE NC 28607
City or Town State Zip Code
(828 )_ 773-4889
Area code- Phone number 12. REMARKS:
5 GPM 128-134
6.WELL DETAILS: 25 GPM 168-169
a. TOTAL DEPTH: 205
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: 60 FT. R ORD HAS�EEN PROVID THE WELL VOWNER.
(Use"+"if Above Top of Casing)
d. TOP OF CASING IS 1 FT.Above Land Surface. 1 16
*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): 30 METHOD OF TEST AIR PRINTED NAME OF PERSON CONSTRUCTING THE WELL
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. Rev.3/07

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