GW1-2023-02238_Well Construction - GW1_20230307

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RESIDENTIAL WELL CONSTRUCTION RECORD
rg g' North Carolina Department of Environment and Natural Resources-Divisionlof Water Quality •
��` "'•" WELL CONTRACTOR CERTIFICATION# 2780 210073
1.WELL CONTRACTOR: f. DISINFECTION:Type HTH Amount 85
KEITH PRESNELL g. WATER ZONES(depth):
Well Contractor(Individual)Name
From 330 To 345 From • To.
DEWEY WRIGHT WELL&PUMP CO., INC From To From To
Well Contractor Company Name From To From To
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STREET ADDRESS PO BOX 308 7. CASING: Thickness/
Depth Diameter Weight Material
BOONE NC 28607 From 0 To 166 Ft. 6 1/4 188 • GA! V
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
SITE WELL ID#(itapplicable) _ From 0 To 20_Ft. BENTONIT GRAVITY
From To Ft. 25 BAGS
WELL CONSTRUCTION PERMIT# 132032 From To Ft.
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 2/15/2023 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: ZIONVILLE COUNTY WATAUGA Depth Size Material
From To Ft.
OFF QUAIL TRAIL OFF HARLEY PERRY OFF HWY 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 — _ 36.304719 minutes,seconds or 0 160 DIRT
LONGITUDE 81.732465 in a decimal format 160 190 GRANITE
— — 190 200 GRANITE QUARTZ
Latitude/longitude source: )6 GPS I Topographic map 200 265 GRANITE
(location of well must be shown on a USGS topo map and 265 280 SHALE
attached to this form if not using GPS) 280 330 GRANITE r'—' ---- --;. ,._,_,
330 345 QUARTZ
5.WELL OWNER
345 440 GRANITE
OWNER'S NAME MICHAEL WHITT 440 460 SHALE qq nn jp�
STREET ADDRESS 616 AUBREY CLAYTON RD 460 505 GRANITE Ili 11\ !� 7 2023
HURDIE MILLS NC 27541 In'-r7.;:_•'�'1 7),7,.7 .-„i l-'P°i
City or Town State Zip Code
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(336 )-.503-2818
Area code- Phone number 12. REMARKS:
2 GPM 330-345
6.WELL DETAILS:
a. TOTAL DEPTH: 505
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 TANDARDS,AND THAT A COPY OF THIS
c. WATER LEVEL Below Top of Casing: 100 FT. RECORD HAS BEEN PROVIDED TO T E NELL OWNER.
(Use'f'if Above Top of Casing)
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d. TOP OF CASING IS 1 FT.Above Land Surface*
*Top of casing terminated at/or below land surface may require SIGNATURE OF CE IFIED WELL C NTRA DATE
a variance in accordance with 15A NCAC 2C.0118. KEITH PRESNELL
e. YIELD(gpm): 2 - 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-la
1617 Mail Service Center—Raleigh,NC 27699-1617 Phone No.[phone] ext 568. I Rev.3/07

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