GW1-2023-01816_Well Construction - GW1_20230223

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I .`. RESIDENTIAL WELL CONSTRUCTION RECORD
s },' g- North Carolina Department of Environment and Natural Resources-Division of Water Quality
a., WELL CONTRACTOR CERTIFICATION# 2780 220097 •
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/
Depth Diameter Weight Material
BOONE NC 28607 From n To 4n Ft. 6 1/8 350 PVC,
City or Town State Zip Code From To Ft.
(828 )_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. 18 BAGS
WELL CONSTRUCTION PERMIT#.337470 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 2/3/2023 From To Ft. in. in.
TIME COMPLETED 03:00 AM 0 PM IIX From To Ft. in. in.
4.WELL LOCATION: 10.SAND/GRAVEL PACK:
CITY: DRY HOLE COUNTY WATAUGA Depth Size Material •
From To Ft.
#213 OFF GEORGIA AVE OFF CAMP ROCK OFF C From To Ft.
(Street Name,Numbers,Community,Subdivision,Lot No.,Parcel,Zip Code) From To Ft.
TOPOGRAPHIC/LAND SETTING:
0 Slope I Valley II Flat 0 Ridge 0 Other 11. DRILLING LOG
(check appropriate box)
May be in degrees, From To Formation Description
LATITUDE — 36.20058 minutes,seconds or 0 50 DIRT
LONGITUDE 81.62726W in a decimal format 50 220 GRANITE
— — 220 225 QUARTZ
Latitude/longitude source: X GPS ii Topographic map 225 430 GRANITE
(location of well must be shown on a USGS topo map and 430 450 SHALE
attached to this form if not using GPS) 450 590 GRANITE
590 600 SHALE
5.WELL OWNER 600 700 GRANITE n
OWNER'S NAME CHRIS CURTIS i" _ • -: . , ,' .,..t
STREET ADDRESS 213 GEORGIA AVE
BOONE NC 28607 f'te `3, fz 2023
City or Town State Zip Code
(828 )_ 964-2932 .•�...,�q":-)Unlit
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Area code- Phone number
12. REMARKS: -
6.WELL DETAILS:
a. TOTAL DEPTH: 700
b. DOES WELL REPLACE EXISTING WELL? YES I NOX I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
15A NCAC 2C,WELL CONSTRU TION STANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 700 FT, RE ORD HAS BEE P OVIDE THE WELL OWNER. �j
ks(Use"+"if Above Top of Casing) / ��n/J ~
d. TOP OF CASING IS 1 FT.Above Land Surface` • d?__ !
*Top of casing terminated at/or below land surface may require IGNATURE OF CERTIFIED ELL 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
Submit the original to the Division of Water Quality within 30 days. Attn: Information Mgt., Form GW-1 a
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07

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